Search PubMed⌕ Search

Biomedical subjects

M Riquet

Publications and source records attributed to M Riquet.

At least 91 records · Page 5Linked to original sources
PubMed1997

[Pericardial effusion and mediastinal "tumor": case report of an unusual association].

A young man aged 26 was admitted as an emergency to the thoracic surgical unit for a pericardial tamponade associated with a tumour in the left anterosuperior mediastinum. After pericardial drainage by the sub-xiphoid route a left anterior mediastinotomy showed that the tumour had disappeared and a flabby diverticulum of the pericardium was found which was resected. Pericardial diverticulae are coelomic cysts which are usually considered to be congenital in origin similar to the pleuro-pericardiac cysts to which they are attached. The clinical history, which had a particularly dramatic and alarming onset is in favour of an acquired disease which is equally possible in this type of lesion.

Adult↗
PubMed1997

[Mucoepidermoid tracheobronchial tumors. Apropos of a series of 11 cases].

Mucoepidermoid tumours (TME) are rare tumours which develop at the level of the submucous bronchial glands of the tracheobronchial tree. The majority of these tumours develop in a benign fashion but some of them are malign. Amongst these many are probably confused with adenosquamous bronchial cancers. We have reviewed eleven patients suffering from TME who were observed over a period of twelve years. Two of these tumours were at the level of the trachea: nine others were at the level of the bronchial cartilaginous trachea. Seven of these tumours had the macroscopic and histological criteria of low grade malignancy and four corresponded to those tumours said to show high grade malignancy. The only death concerned a patient with a tracheal tumor of high grade malignancy but the death occurred immediately after laser therapy to relieve obstruction in a patient with acute asphyxia. None of the other patients died of tumour progression and the longest follow up (eleven years of survival) involved a patient with a bronchial form and a high grade malignancy with glandular invasion. Even mucoepidermoid tumours of high grade malignancy have a good prognosis and it is a cardinal point to clearly distinguish these forms from adenosquamous cancers. Nevertheless it has been suggested that adenosquamous and mucoepidermoid carcinomas could have a common origin and be the extremes of the same overall disorder just as the image we have of neuroendocrine tumours whose spectrum extends from carcinoid tumours to small cell cancers.

Adult↗
PubMed1997

[Surgery of thoracic and pulmonary tuberculosis and the sequelae of its treatment in adults].

Surgery for tuberculosis was the starting point for thoracic and cardiovascular surgery in the modern day, but its place was more and more restricted to the treatment of the disease. Excisions (lobectomies, pneumonectomies, segmentestomies) currently represent the majority of operations, after this come operations on the pleura (decortication) and rarely those on the thoracic wall (thoracoplasty, parietectomy). The indications for excision are principally encountered with disease of the parenchyma itself: progressive disease under treatment or with resistant tubercle bacilli, sequelae of parenchymal complications (infections, aspergilloma or haemoptysis) and certain forms of atypical mycobacteria, and also a small but significant group in which excisions are aimed at diagnosis. Sometimes excisions are associated by necessity with decortication for pleural disease which may or may not have originally been intended for the underlying parenchyma or the lesions may be the sequelae of previous complications of treatment such as collapse therapy. Occasionally surgery is indicated in the treatment of lymph node masses in the mediastinum which have not responded to antituberculous therapy and during the treatment bronchial complications have evolved or there have been other sequelae. As for the indications for surgery of the thoracic wall such as thoracoplasty, they appear more than ever obsolete and even if they are still used in certain complications of surgery, they have apart from a few exceptions, lost their original therapeutic role in tuberculosis. However, currently there is a recrudescence of tuberculosis favoured by certain socio-economic situations and strengthened by the appearance of TB cultures which are more and more resistant. The surgery of tuberculosis in its oldest forms (thoracoplasty and removal of cavities) can no longer be said to be the surgery of the past. They proved in the old days that they could cure. Surgery has once more its place in the therapeutic arsenal of new forms of the disease and indirectly in limiting the risk of spread it has a role to play in prevention.

Adult↗
PubMed1996

[Prognostic factors of operated non-small-cell bronchogenic cancer: critical analysis of T.N.M].

A prospective study of prognosis factors for operated non-small-cell bronchogenic cancer was conducted to assess those proposed by the T.N.M. classification. From April 1984 to December 1993, 918 patients aged 32 to 83 years underwent surgery: 389 stage I; 367 stage II; 367 stage IIIa; and 25 stage IIIb. Macroscopic exeresis was satisfactory in all patients and node dissection of the mediastinum was performed. Post-operative mortality was 4%. Overall actuarial survival at 5 years was 43.9%, stage I 59.5%; stage II 53.8%; stage IIIa 25.1%; stage IIIb 29.3%. Tumor size, presence of visceral pleural invasion, and presence of local invasion (T3 and T4) worsened prognosis (concerning T). The prognosis value of N was the determining element: survival at 5 years, 56.3% for N0; 47.5% for N1 and 20% for N2. When metastases invaded two node chains in combinaison with T3, prognosis was poor. These cancers were stage IV.

Adult↗
PubMed1996

[Cervical venous anastomoses of pulmonary lymphatic origin].

The aim of this study was to describe in detail the anastomoses between pulmonary lymphatic vessels and veins of the neck so as to better understand certain complications in thoracic surgery. Lymphatic vessels of 687 pulmonary segments in 360 cadavers were injected. Detailed study of the end of the right paratracheal, right thoraco oesophageal, left preaorticocarotid and left recurrent lymph node chains was undertaken. The results showed the absence of any major right lymphatic duct. There were, however, many lymphatic arches draining into the jugulo-subclavian confluent ipsilaterally and, in 10 to 25% of cases, contralaterally, as well. The intertracheobronchial lymph nodes also drained into the venous confluents of the neck, via direct lymphatic vessels, without lymph node relays. Lastly, the left mediastinal lymph node chains were frequently found to drain into the arch of the thoracic duct (40% of cases), and reflux by valvular incompetence at this level could be an explanation for chylous pericarditis and some chylothoraxes after surgery.

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

Factors determining survival in resected N2 lung cancer.

This retrospective study was based on 237 patients with non-small cell lung cancer (NSCLC) and nodal N2 disease. All accessible mediastinal lymph nodes (LN) were removed and classified according to their anatomical location in LN chains. The pulmonary resections performed were: pneumonectomy (n = 187), lobectomy (n = 44) and segmentectomy (n = 4). There was solitary nodal chain involvement by metastasis in 141 cases, two chains in 72 cases and three or more in 24; "skip" metastases were present in 26.6%. N2 disease would have been missed in 45 cases of single chain involvement (31.9%) if routine removal of mediastinal nodes had not been performed. The overall 5-year survival rate was 18.8%. Survival was not influenced by site, size or extension (T) of tumor, tumor histology or the presence of vascular invasion. The prognosis was significantly worsened by the presence of microscopic residual disease (30 cases) and of satellite nodules (23 cases). Survival was significantly improved when metastases involved a single LN chain (26.3 versus 8.3%, P = 0.0003). The location and number of involved nodes in the chain, "skip" metastases and the presence of extracapsular spread of carcinoma did not influence the prognosis. Routine mediastinal LN dissection is necessary to improve survival and for classification of lung cancer. Anatomic description allows better understanding of N2 disease which is not a contraindication to surgery when a gross complete resection can be achieved.

Carcinoma, Non-Small-Cell Lung↗
PubMed1995

Hilar lymph nodes: identification with spiral CT and histologic correlation.

PURPOSE: To determine the appearance of normal hilar lymph nodes and associated soft tissue at spiral computed tomography (CT). MATERIALS AND METHODS: At spiral CT in 50 healthy patients, peribronchovascular hypoattenuated areas of 42 right and 45 left hila were systematically evaluated. Histologic results were correlated in five additional cases. RESULTS: Hilar lymph nodes were depicted (a) in the right hilum (lateral to A2 [n = 33 (79%)], medial [n = 29 (69%)] or lateral [n = 11 (26%)] to the interlobar pulmonary artery, and medial to the lower-lobe pulmonary artery [n = 30 (71%)], A7 [n = 9 (21%)], and A8-10 [n = 8 (19%)]; and (b) in the left hilum (lateral to A2 [n = 22 (49%)], medial to the interlobar pulmonary artery [n = 45 (100%)], and the lower-lobe pulmonary artery [n = 27 (60%)], and in the angles of bifurcation of A7 + 8 and A9 + 10 [n = 18 (40%)]). Hilar lymph nodes were seen to be triangular or linear and to be less than 3 mm wide except around the left-lower-lobe pulmonary artery. CONCLUSION: Spiral CT accurately depicts normal hilar lymph nodes and their major anatomic relationships.

Contrast Media↗
PubMed1995

[The surgical management of pneumothorax in patients with AIDS].

The occurrence of a pneumothorax occurring as a complication of AIDS is a poor prognostic sign. We have undertaken a review of 26 patients admitted to hospital for a pneumothorax of whom 25 were admitted for therapy: five resolved under simple drainage; twenty required a pleurodesis which was performed on thirteen under video thoracoscopy: these were recurrent pneumothoraces and were bilateral in half the patients; all had failed under simple drainage. The hospital mortality was 30%; the follow-up was unusually long in the majority of cases and only 20% had a simple follow-up. The analysis of this population showed that the results were not tied to the proposed treatment but to the state of the disease and to the pre-existence of pulmonary lesions most often in relation to pneumocystis. Video thoracoscopy enables one to inspect the lung and to resect the diseased area at the origin of the air leak. The technique also enables the pleurodesis to be achieved and a pleural or lung biopsy to be obtained in a relative non-invasive fashion.

AIDS-Related Opportunistic Infections↗
PubMed1995

[Video thoracoscopy of pulmonary nodules. Can one avoid preoperative markers?].

For a period of 35 months, 50 patients presenting with a total of 61 peripheral pulmonary nodules were operated on under videothoracoscopy. As a matter of principle none of these nodules were marked radiologically pre-operatively. All the scanners were reviewed retrospectively by a radiologist and a thoracic surgeon without knowing the results of the thoracoscopic intervention: 23 of these patients on the evidence would have quite obviously required preoperative marking (group I), and 27 would have been presented for direct thoracoscopy (group II). In group I there was only one group of nodules which could not be localised and by necessity, a thoracotomy was required. In group II, two nodules could only be localised thanks to a mino-thoracotomy. The level of failure was between 4 and 7%, and was identical to that found in the literature for different techniques of pre-operative radiological marking: these techniques were often complicated by a pneumothorax and intrapulmonary haemorrhage. These techniques for marking are used extensively. Prospective studies based on precise and complete criteria should enable better definition of rare cases which might benefit.

Adult↗
PubMed1995

[Tuberculous adenopathies of the mediastinum: surgical experience in adults].

Fifty eight patients were treated for mediastinal tuberculous adenopathies in the thoracic surgery department from 1986 to 1992. Surgery was diagnostic in 49: mediastinoscopy n = 42, left anterior mediastinotomy n = 3, thoracotomy n = 3 and video assisted surgery n = 1. Surgery was in view of cure in 9: bronchial fistula despite medical treatment n = 6, recurrence under medical treatment n = 3. Mediastinal tuberculous adenopathies rarely complicate in adults. Surgical treatment is quickly effective in prolonging and complicating cases under medical treatment and also probably diminishes the risk of bronchial and pulmonary sequellaes.

Adolescent↗
PubMed1994

Anatomic basis of lymphatic spread of lung carcinoma to the mediastinum: anatomo-clinical correlations.

Correlation of the anatomic and surgical features in 360 cadavers and in 260 patients operated for bronchial carcinoma reveals that the lymphatics of the lung reach the ipsilateral mediastinum, sometimes directly and sometimes by sites which do not correspond to the anatomic site of the injection or of the pulmonary lesion. This implies the need for systematic eradication of all the lymph nodes of the ipsilateral mediastinum during surgery for bronchial carcinoma. In cases of tumoral lesions (N2), the prognosis is better when only one site is involved, whether the nodal disease is microscopic, uni- or multiglandular, with or without rupture of the capsule and whatever treatment is carried out, even when resection seems macroscopically complete to the surgeon. This is explicable in the light of the anatomic study, which shows that the lymph node chain is a functional entity which channels the lymph into the systemic circulation, either at the venous confluence of the neck or into the thoracic duct in the mediastinum. When only a single chain is affected, there is a greater than 70% chance that systemic metastases are already present, 90% when N2 affects 2 chains, while in N3 cases (lymph passage to contralateral chains) the incidence reaches virtually 100%. However, macroscopically satisfactory excision allows management of the local problem, and involvement of the mediastinal nodes, even with capsular rupture, cannot be considered as a contraindication in the absence of clinically detectable systemic metastases.

Adult↗