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Biomedical subjects

J Mouroux

Publications and source records attributed to J Mouroux.

At least 55 records · Page 3Linked to original sources
PubMed1996

Pleuropericardial cysts: treatment by videothoracoscopy.

Four cases of pleuropericardial cyst (three symptomatic, one in an unusual location) were treated by videothoracoscopy. Complete resection of the cyst was possible in all cases. The postoperative course was uneventful and patients were discharged on the 4th or 5th day. Pleuropericardial cysts account for 5 to 10% of all mediastinal tumors. Clinical latency and a benign course are characteristic features. In most cases, computed tomography (CT) confirms the diagnosis. When the cyst is symptomatic or the diagnosis is in doubt (atypical location, high density on CT scans), videothoracoscopy offers an alternative to transpleural puncture with evacuation or excision via thoracotomy.

Adult↗
PubMed1995

Surgical management of thoracic manifestations in human immunodeficiency virus-positive patients: indications and results.

The records of 97 patients with thoracic complications of human immunodeficiency virus (HIV) were analysed to determine the reasons for surgery and the results of these procedures. Of the patients, 79 underwent surgery; the remaining 18 were managed non-surgically. A total of 36 procedures were performed for diagnostic purposes: mediastinoscopy (21 patients), lung biopsy (15 patients). Therapeutic procedures were performed in 61 patients to treat pneumothorax (23 cases) or empyema thoracis (18 cases), for resection of pulmonary lesions (13 cases), and to treat various other pathologies (seven cases). Ten patients died in hospital: seven after surgery and three after a nonsurgical procedure. Eleven patients developed a postoperative complication. Hospital mortality varied from 0 per cent to 20 per cent, depending on the procedure. The mortality rate appears to be linked to the stage of HIV infection at the time of therapy rather than to the type of procedure performed. Surgical decisions must take into account the patient's Centers for Disease Control stage and physiological status, therapeutic possibilities, and the prognosis of the pathology requiring treatment.

AIDS-Related Opportunistic Infections↗
PubMed1995

Videothoracoscopic excision of thoracic neurogenic tumors.

BACKGROUND: Videothoracoscopic surgery is a new procedure for treating neurogenic tumors of the thorax. Feasibility and utility of this technique are not yet well defined. METHODS: Over a 26-month period, 26 neurogenic tumors of the thorax were treated in five general thoracic surgery centers performing videothoracoscopic surgery. Indications and contraindications for this new procedure and initial results were retrospectively studied. RESULTS: Contraindications to videothoracoscopy included intraspinal extension of the tumor (n = 3), spinal artery involvement (n = 2), tumors more than 6 cm in diameter borderline located within the thorax (n = 2), and middle mediastinal location (n = 1). Videothoracoscopy was performed in 18 patients. Conversion to thoracotomy was required in 3. In 1 patients, subsequent chest wall resection was performed because of malignancy. Postoperative hospital stay was uneventful. It was shorter after videothoracoscopy. Postsurgical pain was more acute in patients who had thoracotomy or conversion to thoracotomy. CONCLUSIONS: Videothorascopy is a good alternative for managing neurogenic tumors of the thorax when deemed feasible. There is a tendency toward a shorter hospital stay with less pain in patients treated by this new procedure.

Adolescent↗
PubMed1995

[Para-esophageal hernias. Apropos of 42 cases].

Between 1979 and May 1994, 42 patients (11 males, 31 females, mean age 72.8 +/- 12.4 years) underwent surgery for paraoesophageal hiatal hernia. In 37 cases, clinical signs had been observed for 64 months on the average: digestive (32), respiratory (15), cardiac (9). Nine patients had iron deficiency anaemia. Eighteen patients had a complication (acute obstruction: 10, haemorrhage: 6, perforation: 2, lung infection: 2). In 5 cases, the complication was the inaugural sign. Surgery was performed in a emergency situation in 5 cases and deferred emergency in 12 and surgery was elective in 25. An antireflux procedure was used in 36 cases (Lortat-Jacob (2), Toupet (5), Dor (2), Nissen-Rossetti (27)). Another procedure was also needed in 12 patients. There were no postoperative deaths and complications occurred in 6 patients (14.9%). Outcome was known in 40 patients with a mean follow-up of 40.5 months (range 3 to 140 months). Functional results was very good in 35 patients (87.5%), good in 3 (7.5%) and poor in 2 (5%). The most satisfactory immediate results were obtained for patients who had elective surgery and in those with a deferred emergency. Use of the Nissen-Rossetti procedure did not have any deleterious effect on these results and no long-term inconveniences.

Acute Disease↗
PubMed1994

[Current surgical methods for the etiological diagnosis of mediastinal adenopathies].

The aim of this work was to determine the role of video-thoracoscopy and mediastinoscopy for the diagnosis of lymph node enlargement in the mediastinum of unknown aetiology. From January 1992 to December 1993, 26 patients were seen for surgical biopsy of mediastinal lymph nodes. Relative localization and the requirement for an associated gesture determined the choice between axial mediastinoscopy, parasternal scopy and videothoracoscopy. Mediastinoscopy was performed for peritracheal or right hilar (Baréty) nodes and parasternal scopy for anterior mediastinal masses. Videothroacoscopy was performed when the lymph nodes were localized at the preceding sites or when an associated manoeuver was required. Mediastinoscopy was performed in 16 patients. Lymphorrea which subsided after 4 days occurred in one patient and the mean hospital stay was 2.6 days. Diagnosis was achieved in 15 cases. The delay from procedure to treatment was 11 days on the average. Parasternal scopy was used 3 times and gave the diagnosis in all cases. Videothoracoscopy was used for 7 patients including 2 cases with pulmonary biopsies. Diagnosis was established 7 times and the delay to treatment was 12 days. No diagnostic thoracotomie were performed during this period. When access to the mass to be biopsied is difficult with mediastinoscopy (aorto-pulmonary, subcarenal, triangular ligament) videothoracotomy can be useful. Post-operative follow-up is simple and a specific treatment can be instaured rapidly. Videothoracotomy should be an important supplementary method for mediastinoscopy and helping avoid thoracotomy.

Adolescent↗
PubMed1994

[Oncological and functional results of direct colo-anal anastomosis after total resection of the rectum for cancer].

From january 1986 to december 1992, 71 patients underwent direct colo-anal anastomosis as described by Parks (CAA) after total rectal resection for carcinoma: 49 men and 22 women with a mean age of 64 years (range 37-82). In 67 cases, the indication was for adenocarcinoma of the mid and low rectum, and in 4 cases for carcinoma of the upper rectum associated with a low rectal benign tumour (6 Dukes A, 36 Dukes B, 21 Dukes C, 8 Dukes D). A diverting colostomy was constructed in all cases. One patient died from pulmonary embolism (mortality: 1.4%). Anastomotic leakage occurred in 6 cases (8.5%). None of these cases required reoperation and all colostomies have been closed. Local recurrence occurred in 12 cases (17%) 6 to 34 months after CAA, of whom 4 were treated by abdominoperineal resection. Eleven patients died from local recurrence (3 cases) or distant metastasis (8 cases). Actuarial survival at 1, 2, 3, 4 and 5 years was 92%, 88%, 78%, 75% and 69% respectively. From the functional point of view, one patient underwent abdomino-perineal resection for incontinence 3 years after CAA. All the other patients were fully continent, with a mean stool frequency of 2 per day, and good gas-stool discrimination. Twenty per cent of patients presented soiling, 20% with stool frequency, and 12% with urgency. Long term functional and oncological results make CAA a good alternative to abdomino-perineal resection for mid and low rectal carcinoma.

Adenocarcinoma↗
PubMed1994

[Video-assisted thoracic surgery: indications and limitations].

From November 1990 to September 1992, 72 patients underwent a video-assisted thoracic surgery (VATS), 47 men and 25 women, of mean age 49 years. Video-assisted thoracic surgery was indicated for the following: 44 spontaneous pneumothorax, 6 benign tumors of the lung or the mediastinum, 4 pleural effusions, one broncho-pleural fistula and one sympathectomy; 17 diagnostic procedures (lung or mediastinal lymph-nodes biopsies). In one patient, it was necessary to associate a mini-thoracotomy and 5 patients went on to a formal thoracotomy. There was no mortality and the morbidity rate was 5.5%. Some conditions are required: one-lung ventilation, ability to convert to a formal thoracotomy at any moment. It is contra-indicated in cases of single lung or complete obliteration of the pleural space due to dense adhesions. The place of VATS is now well defined for the treatment of spontaneous pneumothorax. It is discussed for resection of pulmonary diseases depending on their size, location and histologic type.

Adolescent↗
PubMed1993

Chest wall invasion by bronchogenic carcinoma: evaluation with MR imaging.

The value of magnetic resonance (MR) imaging and the roles of various pulse sequences and contrast medium enhancement in detection of chest wall invasion were evaluated in 34 patients with primary bronchogenic carcinoma. Results were correlated with clinical data and computed tomographic studies. MR imaging criteria of parietal invasion included signal intensity identical to that of the tumor on T1-weighted images, intraparietal hyperintense signal of the tumor on T2-weighted images, and intraparietal enhancement with T1-weighted imaging and gadoterate meglumine administration. Twenty patients had parietal involvement, and MR imaging was positive in 18 of the 20 (sensitivity, 90%). Two false-positive errors occurred among the 14 patients without parietal involvement (specificity, 86%). T2-weighted sequences had a sensitivity of 65% (11 of 17 cases). Contrast-enhanced and non-contrast-enhanced T1-weighted sequences had the same sensitivity, but contrast medium uptake was revealed in two patients without parietal involvement. Good spatial resolution appears to be the main factor for detection of parietal invasion.

Adult↗
PubMed1993

[Traumas of the duodenum].

The aim of this study is to present current management of duodenal trauma. Duodenal lesions following penetrating injuries are rare, but more serious, than those following blunt injuries. the severity is mostly due to delay in the diagnosis and associated intraabdominal injuries. Diagnosis is based on abdominal plain film, gastroduodenography, and more recently US scan and CT-scan. Surgical procedures depend on the type of lesion. In patients operated early, a duodenal wound can be treated by suture-closure with duodenal decompression tube. If suture-closure is not available, with a wound affecting proximal or distal duodenum, resection with anastomosis can be performed. In the second portion of the duodenum, the best treatment is a jejunal plasty with a Roux-en-Y loop. When there is an associated pancreatic injury, treatment depends on whether biliary or pancreatic ducts are injured, and a pancreatico-duodenectomy could be necessary. In patients operated on later, closure with duodenal exclusion by diverticulization is associated due to the high risk of leaking.

Duodenal Diseases↗
PubMed1993

[Pleuro-pericardial cysts, treatment by video-assisted surgery].

Three cases of symptomatic pleuro-pericardic cysts were treated with video-assisted surgery. Complete exercises of the cysts was possible in all cases. The follow-up was uneventful and hospitalization was 4 to 5 days. Pleuro-pericardic cysts represent 5 to 10% of the mediastinal tumours. Clinical latency and a constantly benign course are characteristic features. In most cases, tomodensitometry confirms the diagnosis. The diagnosis may be uncertain only in symptomatic forms (atypical localization, high density on tomodensitometry). In these cases, video-assisted surgery is an interesting alternative to transparietal punction-evacuation or to exeresis via thoracotomy.

Adult↗
PubMed1993

[Kaposi sarcoma of the lungs in patients with acquired immunodeficiency syndrome (AIDS). Thoracic radiography and scanning].

Twenty-four patients with AIDS presenting with Kaposi's sarcoma of the lung were retrospectively studied to assess the merits of thoracic radiographs and of CT for the diagnosis of this disease. Evidence for Kaposi's sarcoma of the lung was given by a characteristic fiberendoscopic appearance in 10 cases and by the histologic diagnosis in 14 cases. All patients had chest radiographs and 14 patients a concomitant thoracic CT study. Chest radiographs showed perihilar opacities in 18 patients, nodules in 8, mediastinal and/or hilar adenopathies in 2 and pleural effusion in 16. Comparison of the patients who had had thoracic radiographs and a CT scan showed better detection of adenopathies, described in 2 cases on chest radiographs and 7 on CT scans, and of nodules, detected in 5 cases on chest radiographs and 6 on CT scans. In 12 patients with perihilar opacities on thoracic radiographs, CT provided a better view of the peribronchovascular distribution of these opaque areas. In 1 patient, CT showed peribronchovascular thickening while radiographs were normal. In 1 patient, both examinations were normal. This study emphasizes the merits of thoracic radiographs and, even more, of CT for the diagnosis of Kaposi's sarcoma of the lung. Peribronchovascular thickening appears to be a characteristic sign that is well analyzed with computed tomography. Since histological evidence of Kaposi's sarcoma is rarely obtained because of the aggressive nature of biopsies in such patients, CT has an important role for the diagnosis of this condition.

AIDS-Related Opportunistic Infections↗
PubMed1993

[Toxoplasmosis in AIDS patients. Pathoclinical study of 78 cases].

We report 78 cases of toxoplasmosis diagnosed between 1987 and 1992, from an autopsy study of 205 patients infected by the human immunodeficiency virus (HIV). Of the 78 patients 22 were females (28%) and 56 males (72%). Risk factors were as follows: intravenous drug addiction (44 cases, 56%), homosexuality or bisexuality (18 cases; 36%) and multiple blood transfusions (6 cases). Cerebral toxoplasmosis (CT) was diagnosed in 73 cases (93%) and was characterized by abscesses (59 cases), diffuse encephalitic lesions (8 cases), isolated cysts without inflammation (3 cases) and hemispheric involvement with ventricular hemorrhage (3 cases). Cerebral involvement were isolated (55/78 cases; 70%) or associated with multi-visceral diffusion (18/78 cases; 23%). Isolated extracerebral localization was observed in 5 cases. The most frequent extracerebral sites were: cardiac (21 cases), pulmonary (14 cases) and pancreatic (7 cases). Immunohistochemical study with anti Toxoplasma gondii antibodies allowed to a diagnosis of extracerebral localization in 8 cases. Ultrastructural features of Toxoplasma gondii were studied on post mortem myocardial samples (2 cases) open lung biopsy (1 case) and bladder biopsy specimen (1 case). Antemortem diagnosis of cerebral toxoplasmosis was performed on CT-scan in 59/73 (80%). Antemortem diagnosis of extracerebral toxoplasmosis was performed or suspected in 8/23 cases (34%): by isolation of trophozoites in bronchoalveolar lavage (2 cases), on an open lung biopsy (1 case) and on a bladder biopsy specimen (1 case), and by clinical and echocardiographic data (4 cases). Anti-toxoplasmic serology allowed to the diagnosis of toxoplasmosis in 12/78 cases (15%) by showing high levels of IgG in the serum.(ABSTRACT TRUNCATED AT 250 WORDS)

AIDS-Related Opportunistic Infections↗