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Biomedical subjects

P Fuentes

Publications and source records attributed to P Fuentes.

At least 91 records · Page 5Linked to original sources
PubMed1993

[Video-assisted pulmonary resection surgery. Technique, indications and first results].

Video-assisted thoracic surgery (VATS) is a compromise between conventional thoracic surgery performed via a thoracotomy of variable dimensions and surgical videothoracoscopy, which, using only small operating channels, requires the use of specific instruments, gives a field of vision exclusively by video camera and raises the delicate problem of extraction of the resection specimen. VATS is performed via a minithoracotomy, 3.5 to 5 cm long, using a video camera. In this way, the operator has two forms of vision throughout the operation: direct vision through the orifice of the minithoracotomy and visualization of the video screen. This technique also allows extraction of the resection specimen at the end of the operation. Between February and May 1993, 20 patients (14 males and 6 females with a mean age of 56 years) underwent lung resection by VATS (18 lobectomies and 2 pneumonectomies). Eighty-eight patients had a malignant tumour and 2 had a benign disease. Lymph node dissection was routinely performed in patients with a malignant lesion. The mean size of the tumours was 3.2 cm. The operative mortality was nil. The mean operating time was 154 minutes. The postoperative course was uneventful in 14 patients, but two cases of atelectasis on DO, one bronchial infection and one chylothorax, treated medically, were observed. The authors report the current criteria of their indications as the feasibility and reliability of this new technique. Results on pain and patient comfort, postoperative analgesia requirements, recovery of respiratory function and possible long-term sequelae remain to be demonstrated, which is the objective of a current prospective study.

Adenocarcinoma↗
PubMed1993

[Results of surgical treatment of persistent or recurrent pneumothorax].

From 1st January 1988 to 31st December 1991, 107 patients were operated on for spontaneous idiopathic (N = 69) or secondary pneumothorax (N = 38). Surgery was performed for recurrence (63.6%) or failure to respond to management by tube drainage (36.4%). Ninety seven patients underwent pleural abrasion, and 10 underwent parietal pleurectomy. Prolonged continuous epidural analgesia was performed in 57 cases. Postoperative complications occurred in 15 patients (14%). Overall morbidity was significantly higher in patients with chronic lung disease (26.3%) than in patients without chronic lung disease (7.2%) (p < or = 0.01). As far as postoperative hospital stay was concerned, the same significant difference was observed (16.8 days versus 12.7 days) (p < or = 0.005). In patients with idiopathic pneumothorax, postoperative hospital stay was significantly shorter in those with epidural pain relief (11.7 days) than in the others (13.6 days) (p < or = 0.025). No recurrence was observed with a mean follow-up of 27 months. We conclude that: 1) surgery is the most efficient treatment of persistent or recurrent pneumothorax; 2) operative morbidity is related to the underlying lung disease and not to the procedure itself; 3) epidural analgesia is beneficial in this surgery.

Adolescent↗
PubMed1993

[Prognostic value of UICC-1987 classification in primary lung cancers].

In order to test the validity of the new 1987-UICC classification (4th ed.) for lung cancer, data from 456 patients who underwent pulmonary resection for bronchogenic carcinoma from 1980 to 1985 were analysed retrospectively. Overall survival rate was 32.7% at 5 years. Prognostic significance of the tumour formula (pTNM) was assessed by multivariate analysis: N lymph node involvement appeared to be the most pejorative factor (p < or = 10(-5)), followed by the T factor (p < or = 0.002) and the M factor (p < or = 0.01). Respective survival curves were compared. Excluding the correlation between T1 and T2 tumours, the prognosis became significantly more unfavourable as the values for the pTNM classification criterion rose. Differences in prognosis between stages I and II, II and III A, III B and IV were not statistically significant for methodological reasons and inappropriate regroupings. Thus, our results partially confirm the prognostic value of the new international staging system. Meanwhile, this classification constitutes a prerequisite for the evaluation of end-results of therapy and the estimation of prognosis.

Adenocarcinoma↗
PubMed1993

[Electronic sectorial ultrasound endoscopy in benign and malignant tumoral pathology of the stomach. Results in 30 patients].

From October 1991 to July 1992, endoscopic ultrasound examination (EUS) was performed preoperatively in 30 patients with gastrointestinal disease with a new forward-view fiber optic gastroscope with a 5 and 7.5 MHz curved-array linear transducer mounted directly behind the lens. Before EUS examination, endoscopy with biopsy had established the diagnosis of gastric disease in 22 cases: 16 adenocarcinoma, 4 lymphoma, 1 carcinoid tumor and 1 gastric metastasis of a chorionic tumor. In the 8 other cases, endoscopic diagnosis with non productive biopsy was gastric ulcer (1 case), submucosal tumor (5 cases), and large fold gastritis (2 cases). EUS established a correct diagnosis in 6 of these 8 cases (2 leiomyoma, 1 lipoma, 1 lymphoma, 2 gastric linitis). Correct preoperative TN staging was accomplished by EUS in 83.3% and correct preoperative staging for N was accomplished by EUS in 90%. This study shows that EUS a curved-array transducer is useful in preoperative TN staging of gastric tumors.

Adenocarcinoma↗
PubMed1992

[Bronchial cancer associated with atheromatous arteriopathy. Prognostic and therapeutic consequences in pulmonary excision].

Between January 1980 and January 1985, 462 consecutive patients underwent lung resection for bronchogenic carcinoma. Eighty of these patients (17.3 percent) had atherosclerosis involving mainly the coronary arteries (40 percent). The mortality rate was significantly higher in patients with atherosclerosis (10 percent) than in those without it (4.7 percent), but the long-term survival was not affected with the presence of atherosclerosis. The lung carcinoma-atherosclerosis association raises two problems: what investigations should be carried out in this group of patients at risk, and what treatment should be given priority when vascular lesions are present and likely to become complicated by pulmonary surgery? However, the presence of atherosclerosis should not lead to a re-evaluation of the need for lung resection.

Adult↗
PubMed1992

[Castleman's disease. An intrapulmonary isolated form with fissural exteriorization].

We report a well-documented case of Castleman's disease which embodied all the main features of its localized forms, those most frequently described in the literature. This case was particular by its unusual intrapulmonary location and its intra-fissural development, which explains why the diagnosis was not considered preoperatively. A review of the literature showed that beside the localized forms of Castleman's disease multifocal forms have recently been reported; these have a much poorer prognosis, and their treatment has not yet been established.

Adult↗
PubMed1992

Treatment of thymomas. A report of 67 cases.

From 1979 to 1989, 126 patients were treated for thymic tumors. Of these, 67 (53%) had thymomas occurring in 27 men and 40 women; the mean age was 46 years: 24 patients had no symptoms and myasthenia gravis was present in 21 cases. A complete resection was performed in 45 patients, associated in 22 with postoperative adjuvant treatment (radiotherapy, 2; radio- and chemotherapy, 20). Two patients had a partial resection followed by radiotherapy and chemotherapy. Twenty patients had initially only a biopsy and were treated by irradiation in 3 cases, radio- plus chemotherapy in 16, radio- plus chemotherapy and subsequent resection in 1 case. The staging was carried out according to the GETT Classification (stage I A:26; I B:6; II:12; III A:1; III B:18; IVA:4). Thymomas were found to be of predominant epithelial type in 12 cases, predominantly lymphocytic type in 9, and mixed in 46. No recurrence occurred after complete resection. The overall 10-year survival was 71.1%. A good correlation was found according to staging: 96% in stage I; 80% in stage II; 35% in stage III. Presence of myasthenia gravis did not affect the results. The best prognostic factor remains complete resection with postoperative radiotherapy to prevent recurrences. The role of adjuvant chemotherapy needs further evaluation.

Adolescent↗
PubMed1992

[Non-malignant esophagotracheal fistulas in adults. Experience with 35 cases].

Esophagotracheal fistula always constitutes a serious, life-threatening complication. Fistulae occurring during medical intensive care with mechanical ventilation are currently the most frequent. Their diagnosis was strongly suspected by clinical examination of the patient, but was always confirmed by endoscopy which revealed their exact site in relation to the vocal cords or carina, essential information for the choice of incision when it is decided to perform surgery. Twenty-five patients were treated medically. Treatment was always combined with gastrointestinal resting, control of gastro-oesophageal reflux and broad-spectrum systemic antibiotics. There were 19 deaths and 6 fistulae closed spontaneously. Three of these 6 patients developed a secondary tracheal stenosis, 2 of which were treated surgically by resection-anastomosis. Ten fistulae were closed surgically with a good long-term result. The indication for surgery was essentially based on the patients general and infectious status and on his or her respiratory autonomy. Technically, we always combined direct suture of the two organs with interposition of muscular or pleural tissue.

Adult↗
PubMed1992

[Ectatic tumoral thrombosis of the superior vena cava revealing thyroid cancer].

Microscopic angio-invasion by carcinoma of the thyroid is known. Extension into the great veins is much more uncommon. Most of the cases which have been previously described were discovered on post-mortem examination. We report the case of a 55 year-old woman who was found to have an asymptomatic small cervical goiter 6 years ago; during the last 12 months she developed superior vena cave (SVC) syndrome radiological investigation (angiography, CT scan) and surgical exploration showed a carcinoma of the thyroid with intraluminal extension of the tumor leading to thrombosis and ectasia of the SVC. Surgery was performed with resection of the whole thyroid, the SVC and the innominate veins. A double prosthetic venous by pass was then inserted between the innominate veins and right atrium. Five years after resection, the patient has no recurrence or metastasis and no clinical symptom of SVC syndrome. To our knowledge, this is only the third reported case successfully treated by surgery.

Angiography↗
PubMed1992

[Results of surgery of non-small cell primary bronchial cancers. Retrospective analysis of 452 resections].

Data from 452 patients who underwent pulmonary resection for a non small cell bronchogenic carcinoma from 1980 to 1985 were analysed retrospectively. The operative mortality rate was 5.5%. Mortality was significantly increased in patients who underwent enlarged resections for T4 tumors (20%; p < or = 0.05), and in patients who were 70 years and older (12.8%; p < or = 0.05). The overall 5-years survival rate was 32.7% at 5 years. Prognosis in patients who were 70 years and older was similar to that in younger patients. No difference in survival was observed in patients with lymph node metastases with regard to the operative procedure (pneumonectomy versus lobectomy). Survival in patients without lymph node metastases who underwent a lobectomy was similar to those who underwent a conservative resection. Prognostic significance of the histologic cell type and the tumor formula (pTNM) was assessed by multivariable analysis. There were statistically significant differences between squamous cell carcinoma and both adenocarcinoma (p < or = 10(-5)) and undifferentiated carcinoma (p < or = 0.01). This study confirmed the validity of the TNM classification (4th ed) for the accurate prognosis evaluation. Lymph node involvement appeared to be the most pejorative factor (p < or = 10(-5)).

Adult↗
PubMed1992

[Extrapancreatic hypoglycemic tumors. Apropos of a case of pleural fibrosarcoma].

The authors report a case of pleural fibrosarcoma associated with severe hypoglycaemia. Chromatography of the patient's serum and tumour fragments revealed a substance with a high molecular weight and an insulin-like activity. Professor Poffengarger's laboratory identified this substance as Non Suppressible Insulin-Like Protein or NSILAp which induces insulin-like effects on various tissues. A review of the literature is presented in the light of this case.

Adult↗
PubMed1992

[Ectatic tumoral thrombosis of the superior vena cava revealing thyroid cancer].

Microscopic angio-invasion by carcinoma of the thyroid is known. Extension into the great veins is much more uncommon. Most of the cases which have been previously described were discovered on post-mortem examination. We report the case of a 55 year-old woman who was found to have an asymptomatic small cervical goiter 6 years ago; during the last 12 months she developed superior vena cave (SVC) syndrome radiological investigation (angiography, CT scan) and surgical exploration showed a carcinoma of the thyroid with intraluminal extension of the tumor leading to thrombosis and ectasia of the SVC. Surgery was performed with resection of the whole thyroid, the SVC and the innominate veins. A double prosthetic venous by pass was then inserted between the innominate veins and right atrium. Five years after resection, the patient has no recurrence or metastatis and no clinical symptom of SVC syndrome. To our knowledge, this is only the third reported case successfully treated by surgery.

Carcinoma↗
PubMed1991

The relation between seborrheic keratoses and malignant solid tumours. A case-control study.

In order to establish whether or not here is an association between cancer and intense growth of seborrheic keratosis, the so-called Leser-Trelat sign, we conducted a case control study in which the number and features of seborrheic keratosis in 82 patients with recent solid tumours, were compared with 82 age- and sex-matched controls. Neither numbers nor features of seborrheic keratosis differed significantly in patients and controls. Eruptive seborrheic keratosis was noted in only one patient and one control. This study showed that solid malignancies are not generally associated with an increase in the number or size of seborrheic keratosis lesions, thus suggesting that they are not controlled by a hypothetical secretion of growth factors by tumours. Our results suggest that Leser-Trelat is either a coincidence, or at most a very rare sign of unusual types of cancer. We also showed that multiple cherry angiomas, previously reported to be a paraneoplastic sign, are not regularly associated with solid tumours.

Adult↗
PubMed1991

[Prolonged epidural analgesia following thoracotomy. Clinical study and serum levels over five days].

Prolonged continuous epidural analgesia allows perithecal infusion with fentanyl and bupivacaine for 5 postoperative days after thoracic surgery. This study included 27 thoracotomized patients randomised into two groups: group X consisted of 15 subjects, group Y consisted of 12 subjects. Each patient received 33 micrograms/hr or fentanyl for 48 hours, associated with 0.25% bupivacaine in group X, and 0.125% bupivacaine in group Y. Over the three last days, the infusion rate of both drugs was decreased in the two groups. No significant clinical difference appeared between X and Y. No clinical respiratory depression occurred. In group Y, mean plasma bupivacaine concentrations remained significantly lower (p less than 0.05). Mean fentanyl levels did not increase beyond 0.8 ng/ml. The use of 0.125% bupivacaine improved the margin of safety but did not impair clinical analgesia in the study. This method provides good analgesia for thoracotomized patients.

Adult↗
PubMed1990

Inoperable nonmetastatic squamous cell carcinoma of the esophagus managed by concomitant chemotherapy (5-fluorouracil and cisplatin) and radiation therapy.

Thirty-five patients with nonmetastatic squamous cell carcinoma of the esophagus were treated with chemotherapy (5-fluorouracil, cisplatin) and concomitant split-course radiation therapy. All of the patients presented with dysphagia. Treatment consisted of two courses of chemotherapy with 5-FU (1 g/m2/day in continuous infusion for 5 days [days 1 to 5 and days 29 to 33] ) and cisplatin (70 mg/m2 intravenous bolus at days 2 and 30). Radiation therapy was concomitant in two courses delivering 20 Gy in 5 days (days 1 to 5 and days 29 to 33). On the first day of treatment, endoscopic peroral dilation or Nd-YAG laser therapy was usually carried out. At the end of the treatment, all of the patients were capable of oral nutrition. Histoendoscopic confirmation was made 8 weeks after the beginning of the therapy. Twenty-five of the 35 patients had a complete response with negative biopsy findings. There was only one serious complication (fatal myelosuppression) in the only patient who received more than two courses of chemotherapy. Sixteen patients died and 19 were still alive at 3 to 42 months after the beginning of treatment. Overall median survival for the 35 patients is 17 months. Actuarial survival was 55 +/- 18% at 1 year and 41 +/- 21% at 2 years. The median survival of the Stage I and II patients is 28 months. These results confirm that concomitant chemoradiotherapy is capable of producing a very high histoendoscopic complete response rate and improved 1-year and 2-year survival. The use of concentrated split-course radiotherapy enabled the authors to reduce the total length of the treatment to two periods of 5 days, with results that are similar to previous studies using classic radiotherapy for a 5-week to 7-week period.

Adult↗
PubMed1990

[Gastric esophagoplasty in the treatment of cancer of the esophagus].

Between March 1982 and December 1987, 112 patients with oesophageal cancer were treated by gastroplasty following oesophagectomy to restore gastrointestinal continuity. This technique was used in all oesophageal cancers regardless of their site, with the exception of paryngo-oesophageal and oesophago-cardio-fundal cancers. The overall mortality of 12.5% fell to below 6% during the last two years. The postoperative course was straightforward in 54.5% of cases. The most frequent complications were respiratory tract complications (19 cases of ARDS out of 112 patients, i.e. 17%) and fistulae at the oesophago-gastric anastomosis (9 cases out of 112, i.e. 8%). The secondary complications were dominated by anastomotic stenoses (19/98, i.e. 19.3%).

Adult↗