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Biomedical subjects

M Riquet

Publications and source records attributed to M Riquet.

At least 73 records · Page 4Linked to original sources
PubMed1999

[Purulent pleurisy and lung cancer. Non-iatrogenic forms and therapeutic management].

Thoracic empyemas may occur during the course of lung cancer as a post-thoracotomy complication, or after pleural drainage and/or chemotherapy in cases when surgery was unfeasible, or may complicate the natural history of the disease and appear as the clinical event that led to its discovery. This latter situation is a challenge requiring to cure the infection in order to further treat the underlying lung cancer. We reviewed the cases of 18 men aged between 46 and 79 years that were referred to our surgical department from 1984 to 1996 for management of a thoracic empyema with an underlying lung cancer. Initial presentation of empyemas, lung tumor characteristics, treatments performed and their results were analyzed so as to formulate guidelines if possible. Mean duration of 17 empyemas before arrival was 26 days (8 to 60 days) and in one case empyema occurred during diagnostic work-up of an excavated lesion. Frank pus was observed in all cases and micro-organisms were identified in 13 cases. Empyema and diagnosis of lung cancer were concomitant in 15 cases: in 3 cases lung neoplasia was already diagnosed but patients had refused surgery. Empyema was treated by under water-seal chest tube drainage with adjunct fibrinolytic therapy in all cases; 2 elderly and cachectic patients suffering metastatic diffusion died rapidly. The other 16 recovered within one month. In 7 cases management was limited to medical treatment (palliative n = 2, chemotherapy n = 1, chemo combined radiotherapy n = 2 and radiotherapy alone n = 2) but only short survivals were observed (inferior to 10 months). Surgery was possible in 9 (pneumonectomy n = 8, lobectomy n = 1); there was no death; postsurgical empyemas complicated the cause twice but were easily cured by drainage; long term survivals were observed in 3 cases that were p NO. Pleural empyema complicating lung cancer is a rare but challenging situation. Once the pleural empyema has been controlled, surgical resection must be performed when indicated: postoperative complications are rare and long-term survival is possible.

Adenocarcinoma↗
PubMed1999

[Squamous cell carcinoma of the head and neck and pulmonary cancer. Report of 50 cases].

Association of a squamous cell carcinoma of the head and neck and a pulmonary cancer is frequent: prevalence is about 5 to 10 percent. The purpose of this study was to present the survival analysis of 50 patients, previously treated for a squamous cell carcinoma of the head and neck, and then treated for a pulmonary cancer between 1979 and 1996. Four patients were excluded from the analysis. Five pulmonary cancers were synchronous with the head and neck cancer, 41 were metachronous. Metachronous pulmonary cancer was asymptomatic in 87 percent and the mean interval between the two cancers was 53 months. Surgery was performed for every pulmonary cancer. Operative mortality was 11 percent. The overall 5-year survival rate was 25%. Survival rates were linked with the T and N stages of the pulmonary cancer: 46% for T1, 13% for T2 and 0% for T3 and T4, 67% for N0 ans 0% for N1-3. Indications for surgical treatment of synchronous and metachronous pulmonary cancers are discussed.

Aged↗
PubMed1998

Thoracoscopic splanchnicectomy for control of intractable pain in pancreatic cancer.

BACKGROUND: Pain is the most distressing feature of pancreatic cancer. Thoracoscopic splanchnicectomy, first performed in 1993, has caused a resurgence of interest in surgical treatment of such excruciating pain. METHODS: Twenty patients underwent splanchnicectomy for pancreatic cancer pain over a period of 50 months. All were opiate dependent and unable to pursue normal daily life activities. We evaluated the type of splanchnicectomy performed and the long-term results procured. RESULTS: The number of splanchnicectomies was 24: unilateral videothoracoscopic splanchnicectomy, n = 11; unilateral videothoracoscopic splanchnicectomy with associated vagotomy, n = 5; and bilateral videosplanchnicectomy, n = 4. There was no postoperative complication. Pain was totally relieved and drug addiction stopped in 16 patients: 10 with unilateral videothoracoscopic splanchnicectomy, 2 with unilateral videothoracoscopic splanchnicectomy and associated vagotomy, and 4 with bilateral videosplanchnicectomy. Pain was not relieved after 4 unilateral videothoracoscopic splanchnicectomies, but bilateralization was not attempted in that subgroup. CONCLUSIONS: Unilateral videothoracoscopic splanchnicectomy is the treatment of choice of intractable pancreatic pain, affording drug cessation and recovery of daily activity in most patients. Failure may be treated secondarily by bilateralization with excellent results. Bilateral videosplanchnicectomy need not be performed by first intention.

Adult↗
PubMed1998

Axillary lymph node metastases from bronchogenic carcinoma.

BACKGROUND: Axillary lymph node metastases (ALNMs) from bronchogenic carcinoma are rare and their significance may be questioned. A surgical approach may allow a better understanding of the mechanism of their occurrence. METHODS: A retrospective study of 1,486 cases of surgically removed non-small cell lung carcinoma was performed. Twenty-two patients (1.5%) had extrathoracic nodal metastases. Nine of them were ALNMs (<1%). These cases form the basis of this study. RESULTS: In 1 patient ipsilateral ALNM was removed during a lung operation. It was a left non-small cell lung carcinoma invading the chest wall (T3 N2). In the other patients (n = 8) ALNMs were observed during postoperative follow-up; 4 underwent ALNM resection, 2 had radiotherapy, and 2 had symptomatic treatment only. For these 8 patients, in the TNM classification performed after an initial bronchogenic carcinoma operation, the lymph node status was, respectively, N0 in four cases, N1 in three cases, and N2 in one case. Survival ranged from 1 to 10 months, except for one patient who is still alive after more than 5 years. In this case, the ALNM was discovered 4 months after a right lower lobectomy for a T2 N0 adenocarcinoma. CONCLUSIONS: Axillary lymph node metastases may be involved through direct chest wall invasion of bronchogenic carcinoma or retrograde spread from supraclavicular lymphnode block. However, another mechanism seems to be the systemic vascular route.

Aged↗
PubMed1998

Cold abscess of the chest wall: a surgical entity?

BACKGROUND: Cold abscesses of the chest wall are rare tuberculous locations. Because of the resurgence of tuberculosis, this diagnosis must be considered more frequently. METHODS: During a 15-year period (1980 to 1995), 18 patients with one or more cold abscesses of the chest wall were managed in our department. Epidemiologic characteristics, indications, methods and results of operation, and pathogenesis of the abscesses were considered in this retrospective study. RESULTS: Most of the patients were immigrant men. A previous history of tuberculosis was noted in 15 cases (83%). Six patients had concomitant active pulmonary tuberculosis. There was mostly a solitary lesion in the chest wall, the most frequent location being the rib shaft (60%). Before operation the diagnosis was confirmed only in 4 patients (by needle aspiration of the abscess) and presumed in 4 others: an antituberculous chemotherapy was therefore given preoperatively to 8 patients. One patient did not undergo operation after a favorable response to medical treatment. In the other patients, an operation was indicated because of lack of response in 5 patients and the absence of diagnosis in 12 patients. Adequate debridement and a postoperative antituberculous regimen were performed with recurrence prevention in mind. A follow-up was obtained in 11 of the 17 patients undergoing operation. The only patient who required a second operation because of a recurrence at the same location had refused the antituberculous therapy after the first surgical procedure. Locations of the abscesses, computed tomographic scan results, and histologic examinations are in favor of a lymph-borne dissemination of tubercle bacilli. CONCLUSIONS: Because fine-needle aspiration remains an inaccurate diagnostic tool and antituberculous medical treatment is not always efficient, chest wall tuberculous cold abscesses remain in most cases a surgical entity.

Abscess↗
PubMed1998

Elective drainage of the apical chest by posterior approach.

Pneumothorax due to incomplete reexpansion of remaining lung after a thoracic operation is difficult to drain via standard access routes. Apical chest drainage can be placed through a upper posterior point of the back, located in the laterovertebral area at the level of the first or second intercostal space. This technique, which is very safe and well tolerated, avoids the necessity to use thoracoplasty or muscle flap plombage of those residual cavities.

Drainage↗
PubMed1998

Long survival after axillary metastasis from lung cancer.

Right axillary lymph node metastases was observed 4 months after a right lower lobectomy performed for a T2 NO lung adenocarcinoma. After surgical excision and subsequent radiotherapy follow-up was uneventful and the patient is still alive after a 6-year interval. Such isolated metastases are probably of systemic origin.

Adenocarcinoma↗
PubMed1998

[Tumors of the phrenic nerve].

A schwannoma of the phrenic nerve is a rare disorder which presents as a tumour of the anterior mediastinum. It is seen in adults and is usually latent. We report two cases in elderly subjects in whom the phrenic nerve tumour had achieved a significant size. One of these schwannomas had degenerated into sarcomatous change which is the first case reported to the present time.

Aged↗
PubMed1998

[Video-guided surgical resection of solitary pulmonary nodules. Significance of thoraco-conversion in cancer cases. Apropos of 34 cases].

The use of video-guides surgery for major pulmonary resections in cancer patients raises a problem of safety and oncological quality. The aim of this prospective study was to demonstrate the oncological contribution of systematic thoracotomy in suspected stage I cancer patients. Between February 1993 and December 1996, we operated 34 consecutive patients with a solitary primary neoplastic lung nodule using normal fibroscopy and preoperative CT scan to detect mediastinal nodes. The nodules measured a mean 18.5 mm. Diagnosis was confirmed at peroperative pathology examination of the video-guided surgical resection, generally leading to thoracotomy for lobectomy-dissection. The final tumoral stage affirmed the initial diagnosis (stage I) in only 19 cases (56%). Peroperative findings showed that the other patients had more advance disease: 2 stage II (T1N1) (6%), 11 stage IIa (T1N2) (32%) and 2 stage IIIb (satellite nodule in the remaining lobe measuring 6 and 7 cm) (6%). These findings emphasize the importance of complete node dissection as well as the need to carefully palpate the entire lung. Thoracotomy remains the most reliable and reproducible method for safely fulfilling the oncological requirements.

Adenocarcinoma↗
PubMed1997

Cytokine patterns in tuberculous and sarcoid granulomas: correlations with histopathologic features of the granulomatous response.

Cytokines play an important role in granuloma formation, but the extent that cytokine profiles are similar in different granulomatous diseases and whether differences in the histopathologic features of the granulomatous response results from differences in cytokine production have not been evaluated. To investigate these questions, we used RT-PCR to quantify the expression of mRNAs coding for 16 cytokines in granulomatous lymph nodes from patients with tuberculosis and sarcoidosis and from control tissues, and we sought correlations between the level of expression of these cytokines and the histopathologic features of the granulomas. Expression of mRNAs coding for a number of cytokines (IL-1beta, IFN-gamma, TNF-alpha, granulocyte-macrophage (GM)-CSF, IL-12 (p40), and lymphotoxin-beta) was increased in tuberculous and sarcoid granulomas compared with that of control tissues. All sarcoid granulomas were shown to express a Th1 pattern of cytokine mRNAs, while tuberculous lymph nodes expressed either a Th1 or a Th0 profile. GM-CSF and lymphotoxin-beta mRNAs were more abundant in sarcoid than in tuberculous granulomas, whereas IL-8 mRNA was strongly expressed only in tuberculous lymph nodes. Strong expression of GM-CSF, TNF-alpha, and IL-8 by granulomas was shown to be correlated, respectively, with the presence of florid granulomatous lesions, the absence of central necrosis, and the presence of neutrophil infiltration. These results demonstrate that the formation of tuberculous and sarcoid granulomas in humans is associated with the expression of characteristic cytokine profiles and indicate that the expression of certain cytokines is associated with the development of specific pathologic features in the resulting granulomas.

Adult↗
PubMed1997

Cervical venous anastomoses of pulmonary lymphatic vessels.

The aim of this study was to describe in detail the anastomoses between the pulmonary lymphatic vessels and the veins of the neck so as to better understand their role in certain aspects of thoracic surgery. The lymphatic vessels of 687 pulmonary segments in 360 cadavers were injected. A detailed study of the proximal end of the right paratracheal, right tracheo-esophageal, left preaortocarotid and left recurrent lymph node chains was undertaken. The results showed the absence of any major right lymphatic "vein". There were, however, many lymphatic arches draining into the jugulo-subclavian confluence ipsilaterally, and, in 10 to 15% of cases, contralaterally as well. The intertracheobronchial lymph nodes also drained into the venous confluence of the neck via direct lymphatic vessels, without lymph node relays. Finally, the left mediastinal lymph node chains were frequently found to drain into the arch of the thoracic duct (40% of cases), and reflux due to valvular incompetence at this level may account for chylous pericarditis and some cases of chylothorax after surgery.

Humans↗
PubMed1997

Lymphangiohemangioma of the mediastinum.

Lymphangiohemangiomas of the mediastinum are exceedingly rare. Clinically they tend to behave like lymphangiomas. We report 3 new cases. All 3 cases showed both lymphatic and vascular components. One case was associated with a left superior vena cava. In both other cases computed tomography with dynamic scans demonstrated the vascular components. Combined lymphatic venous malformation was thus evidenced in the 3 cases and supports that lymphangiohemangiomas are malformative in origin.

Adolescent↗
PubMed1997

Endothelin-1 in the lungs of patients with pulmonary hypertension.

BACKGROUND: Pulmonary hypertension (PH) is characterized by an increase in vascular tone and an abnormal proliferation of muscle cells in the walls of pulmonary arteries. Recent studies have found high plasma endothelin-1 (ET-1) concentrations in patients with PH. This study was conducted to assess whether elevated circulating ET-1 levels in PH really reflect excessive local pulmonary production. METHODS: We prospectively studied ET-1 concentration in lung specimens from 6 control subjects and 13 patients with severe PH referred for lung or heart-lung transplantation (6 patients had primary PH and 7 PH secondary to congenital heart defect). Endothelin-like immunoreactivity (ET-LI) was measured in plasma and lung tissue, using a radioimmunoassay, after ET-1 extraction. Reverse-phase high-performance liquid chromatography was also performed. RESULTS: Peripheral venous plasma ET-LI concentrations in patients with PH, whatever the cause, were greater than those in controls (10.7 +/- 0.8 vs 5.3 +/- 0.7 pg/ml; P < 0.0005). Pulmonary ET-LI was significantly higher in patients with PH, irrespective of its cause, than in controls (25.2 +/- 5.1 vs 8.1 +/- 1.1 pg/mg, P < 0.03). ET-LI pulmonary concentrations were slightly higher in Eisenmenger than in primary PH, but this was not significant (27.1 +/- 8.6 vs 22.8 +/- 5.4 pg/mg). Linear regression analysis indicated a small but significant correlation between ET-LI pulmonary concentrations and pulmonary vascular resistance in the patients with PH (r = 0.38; P = 0.047). In each case, HPLC separation of ET indicated that most of the immuno-reactivity was detected in the same fraction as ET-1. CONCLUSIONS: The striking increase in ET-1 pulmonary concentration provides new evidence that excessive local pulmonary ET-1 production may contribute to the vascular abnormalities of pulmonary hypertension.

Adult↗
PubMed1997

[Surgical pulmonary biopsies in patients with HIV infection: results apropos of a series of 21 cases].

This retrospective study reports the results of surgical lung biopsies in 21 patients infected by HIV. Diagnostic was assessed by surgical lung biopsies in 66% of cases with a 5% immediate post-operative mortality and a 80% survival rate after one month. Therapeutic management was modified in 38% of cases. These results are in concordance with previously published literature and emphasize that such a procedure should only be performed after other diagnostic procedures, including at least a bronchial endoscopy associated to a BAL and/or transbronchial biopsies.

Adult↗
PubMed1997

Prognostic value of T and N in non small cell lung cancer three centimeters or less in diameter.

OBJECTIVE: Peripheral tumors 3 cm or less in diameter are classified T1, T2 when rupturing the visceral pleura, T3 when invading parietal pleura, chest wall, mediastinal pleura or pericardium and T4 when invading vertebra or mediastinal structures. Our objective was to assess the prognostic significance of T and N status according to the size of such tumors. PATIENTS AND METHODS: Patients (918) were operated upon between April 1984 and December 1991. Surgery included complete resection and mediastinal lymphadenectomy. Tumors 3 cm or less were studied concerning T, N status, histology and survival. RESULTS: There were 314 such tumors (T1 = 215, T2 = 64, T3 = 35, T4 = 6); N status was N0 60.2%, N1 21%, N2 18.8%. Global 5-year survival was 52.59%. In case of N0, survival was 64.63%: T1 = 63.76%, T2 = 71.48%, T3 = 45.71%, T4 = 66.6%; which was not significant. There were 48 tumors 1.0 cm or less in diameter (G1), 111 tumors 1.1-2.0 cm in diameter (G2) and 155 tumors 2.1-3 cm in diameter (G3). The incidence of N0, N1 and N2 disease was 77.1, 10.4 and 12.5%, respectively in G1, 64, 18 and 18% in G2, and 52.3, 26.5 and 21.3% in G3. The 5-year survival rate was 62.46% for G1, 52.91% for G2 and 49.36% for G3 (NS). In cases of N1 and N2, survival was 48.41% and 20.2% which was significant (P < 0.05) but differences between each T and each G were not significant. CONCLUSIONS: Small peripheral cancers spread into mediastinal nodes in 12.5-21.3% of cases, according to the size. This is a warning to perform nodes resections in cases where surgeons intend a videothoracoscopic approach. N2 status is not only an indicator but also a governor of prognosis. Neither T status nor size are determinants of prognosis as far as tumors 3 cm in diameter or less are concerned.

Actuarial Analysis↗
PubMed1997

[Place of radical surgery in the treatment of non-small cell lung cancer. Apropos of 969 cases].

PURPOSE: Retrospective analysis of the results of radical surgery in a series of 969 patients presenting with non-small cell lung cancer. PATIENTS AND METHODS: From April 1984 to December 1981, 969 patients underwent radical surgery with mediastinal node dissection for non-small cell lung cancer. Surgery included 507 pneumonectomies, 447 lobectomies and 15 segmentectomies (for patients suffering from respiratory failure). RESULTS: The rate of intrahospital mortality was 4.3%. The rate of crude survival at 5-years was 45.8%. The tumor size (P = 0.004) and visceral pleura ruptures (P = 0.01) were significantly correlated to the 5-year survival rate that was reaching 56% for patients with no demonstrable metastasis to regional lymph nodes (NO), 46.6% for patients with metastasis to lymph nodes in the peribronchial or the ipsilateral hilar region (N1), and 20.8% for patients with metastasis to the ipsilateral mediastinal and subcarinal lymph nodes (N2) (P = 0.001). In case of stage N2 cancer, the 5-year survival rate was 28.7% when only one anatomical level was involved, and 8.7% when more than one anatomical level was involved (P < 0.0001). CONCLUSION: The main prognostic factor was nodal involvement.

Adult↗