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Biomedical subjects

R Giudicelli

Publications and source records attributed to R Giudicelli.

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

[Surgical treatment of esophageal cancer in patients over 70 years of age].

As the population continues to age, septuagenarian patients with esophageal cancer are frequently referred for surgical treatment. The aim of this study was to analyze with respect to their age the outcome of 386 patients who underwent esophagectomy and simultaneous reconstruction from 1979 to 1994. The portion of patients of 70 years of age and older (14.5%) has slightly increased during the period. Location to the lower third of the esophagus and adenocarcinoma type were prevalent in the 56 elderly patients (Group I), but postsurgical TNM staging was identical to that of the 330 younger patients (Group II). Other clinical features, i.e., preoperative weight loss and presence of co-morbid diseases, however, were comparable in both groups. Pulmonary function, as assessed by spirometry, was significantly worse among the older patients, but blood gas determinations were not different. Operative mortality was comparable among the 2 groups (10.7% vs 11.2%). Major morbidity included anastomotic leak (10.7% vs 13.6%) and pulmonary complications (17.9% vs 20.6%) in both groups. Long term survival was not different in elderly patents (5-year rate: 17%) when compared with that of younger patients (18.9%). These data suggest that 1) esophagectomy can be performed in selected septuagenarian patients with an acceptable risk, and 2) long-term survival with excellent functional status is attainable in this age group in a portion of these patients.

Age Factors↗
PubMed1995

[Subcutaneous cervical emphysema: complication of constipation. Review of the literature].

We report the case of a sixty-eight year old woman with chronic constipation, admitted in the emergency unit for respiratory deficiency and cervical subcutaneous emphysema. Endoscopy of the supradiaphragmatic air and digestive tracts was normal. Acutization of an abdominal syndrome required a laparotomy revealing a fissuration of the subperitoneal rectum on a fecal obstruction. This revealing complication may be explained by the topography of the cervico-thoraco-abdominal diffusion spaces.

Aged↗
PubMed1994

Video-assisted minithoracotomy versus muscle-sparing thoracotomy for performing lobectomy.

We prospectively analyzed the outcome of lobectomy in a cohort of 67 patients. Operative time, postoperative pain, pulmonary function, and early outcome were compared between the patients undergoing video-assisted techniques (n = 44) and those undergoing standard muscle-sparing procedures (n = 23). Pain was quantified daily throughout the first week using the visual analog scale. The forced expiratory volume in 1 second and the forced vital capacity were measured at days 2, 4, and 8 postoperatively. The operative time was significantly longer (p < 0.02) and the postoperative pain was significantly less (p < 0.006) in the group undergoing video-assisted procedures. Pain-related morbidity, the mean duration of air leaks, the duration of chest tube placement, and the hospital stay were all less in the video-assisted group, but the differences did not reach statistical significance. However, the impairment in pulmonary function and the overall morbidity were identical for the two groups. Based on our findings, we conclude that video-assisted minithoracotomy is a safe and reliable approach for performing lobectomies, and that the decreased postoperative pain associated with this minimally invasive approach does not result in preserved pulmonary function and significantly reduced morbidity when compared with a muscle-sparing thoracotomy.

Adult↗
PubMed1994

Extended operation for lung cancer invading the superior vena cava.

Between 1981 and 1991, 845 patients were operated on for right lung cancer. Among them, 50 (6%) had a tumor invading the superior vena cava (SVC). Fifteen patients (14 men and 1 woman, mean age: 58 years) underwent radical resection with concomitant vascular reconstruction. Two patients presented with a superior vena caval syndrome. The SVC was invaded by direct extension from the tumor (n = 11) or by paratracheal nodal involvement (n = 4). The patients required pneumonectomy (n = 13) or upper lobectomy (n = 2), with lateral (n = 11) or circumferential resection (n = 4) of the SVC. The venous pathway was repaired by direct suture (n = 9), prosthetic patch (n = 2) or polytetrafluoroethylene (PTFE) graft (n = 4). Tumor resection was considered macroscopically complete in 12 patients (80%). One patient died postoperatively (7%) and non-fatal complications occurred in 3 (20%). Early patency of the four grafts was assessed by phlebography. In the late course, pulmonary embolism occurred in two patients and extended superior vena caval thrombosis in one; the overall clinical patency rate was 75.7% at 1 and 5 years. Two patients (13.3%) experienced mediastinal recurrence; the overall survival rates at 1 year, 2 years and 5 years were, respectively, 46.7%, 32% and 24% (median: 8.5 months). We conclude that extended resection for lung cancer invading the SVC, when feasible, is justified given the effective control of the primary tumor thereby provided, with an acceptable operative risk.

Adenocarcinoma↗
PubMed1994

Major pulmonary resection by video assisted mini-thoracotomy. Initial experience in 35 patients.

Video-assisted thoracic surgery is emerging as a viable approach to increasingly complex intrathoracic therapeutic procedures. From February to July 1993, 35 patients (25 male, 10 female; mean age = 60 years, range: 17-74) underwent a major pulmonary resection using a video-assisted technique: lobectomy (n = 30) or pneumonectomy (n = 5). Pathology disclosed bronchogenic carcinomas (n = 26), metastases (n = 3), and miscellaneous disorders (n = 6). All procedures required one 10.5 mm port for the video-camera, one 3.5 to 5 cm utility thoracotomy through which surgical instrumentation was inserted and the operative specimen removed, and one occasional supplementary 12 mm port. Lung resections were performed with separated dissection and division of each component of the pedicle. The mean operative time was 145 min (SD: +/- 17). There were two postoperative deaths (5.7%) that were not directly related to the technique. Seven patients (20%) experienced non-fatal complications. After lobectomy, the mean duration of chest tube placement was 7.3 days (SD: +/- 1.6). The mean hospital stay was 11 days (SD: +/- 3). All the patients experienced minor postoperative chest pain. We conclude that video-assisted lung resections are technically feasible without an increased risk.

Adolescent↗
PubMed1994

Video-assisted repair of a ruptured right hemidiaphragm.

Video-assisted thoracic surgery is emerging as a viable approach to increasingly complex intrathoracic therapeutic procedures. We present a case of delayed diagnosis of a ruptured right diaphragm caused by a closed trauma in a young woman. The diaphragm was repaired successfully using a video-assisted procedure. Limited postoperative chest pain and muscular impairment allowed early physical therapy that resulted in an excellent outcome. Video-assisted thoracic surgery is suggested as a new treatment option for traumatic diaphragmatic disorders.

Adult↗
PubMed1994

Is lung cancer surgery justified in patients with coronary artery disease?

Between 1987 and 1992, 21 patients who presented with potentially resectable non-small cell lung cancer and coronary artery disease, underwent a preoperative cardiac catheterization in order to assess the coronary artery anatomy and left ventricular function. There were 20 men and 1 woman whose ages ranged from 57 to 77 years. Patients with triple-vessel disease and poor distal circulation or impaired ventricular function (n = 2) were excluded from myocardial revascularization and pulmonary surgery. Patients with a curable left-main or triple-vessel disease (group I) first underwent surgical (n = 3) or transluminal (n = 4) myocardial revascularization. The remaining patients presented with single- or double-vessel disease, and were operated on without prior myocardial revascularization (group II; n = 12). The thoracic procedures consisted of exploratory thoracotomy in two cases, lung-sparing resection in one, lobectomy in ten, bilobectomy in one and pneumonectomy in five. The overall mortality and morbidity rates were 5.3% and 31.6%, respectively. Four patients (21%) experienced postoperative cardiac complications: fatal myocardial infarction (n = 1) and dysrhythmia (n = 2) in three group II patients (25%), and transient myocardial ischemia in one group I patient (14.3%). The overall survival rate at 5 years was 57.4% for the 17 patients who underwent resection of their cancer. We conclude that 1) lung surgery in patients with non-small cell lung cancer and coronary artery disease is justified in selected cases, 2) previous myocardial revascularization appears to confer protection against the development of postoperative cardiac morbidity.

Adenocarcinoma↗
PubMed1994

Surgical reconstruction of the superior vena cava.

Ten patients (eight men, two women) who underwent surgical reconstruction of the superior vena cava using an expanded polytretrafluoroethylene (ePTFE) prosthesis between 1981 and 1991 were reviewed to assess the therapeutic value of such surgery. The mean (s.d.) age was 55(12) years. Obstruction of the superior vena cava was caused by pulmonary or mediastinal cancer in nine patients and chronic mediastinitis in one. Eight patients had superior vena cava syndrome and two had symptoms of lung disease. The diagnosis of superior vena cava obstruction was made before surgery by computed tomography or superior venacavography in eight patients and during the surgical procedure in two. Tumour resection was performed in five patients. Venous reconstruction was achieved by interposition of an ePTFE graft between the proximal and distal end of the vena cava in three patients and between one (four cases) or two (three cases) tributaries of the superior vena cava and the right atrium in seven. No patient died during the perioperative period. Symptoms of superior vena cava obstruction disappeared promptly after operation in all patients. Postoperative patency was assessed by cavography or computed tomography; all the grafts were patent. During follow-up no patients presented with recurrent superior vena cava syndrome. Eight patients died. The cumulative survival rates were 70, 25 and 12.5% at 1, 2 and 5 years, respectively. Surgical reconstruction of the superior vena cava with an ePTFE prosthesis provided immediate and long-term relief of symptoms of superior vena cava obstruction with a low surgical morbidity, even in patients with unresectable malignancy.

Adult↗
PubMed1994

[Video-assisted pulmonary excision surgery. Technique, indications and initial 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.

Adolescent↗
PubMed1994

Rupture of the thoracic trachea with a Sengstaken-Blakemore tube.

Tracheal rupture from within is uncommon and always iatrogenic. We report a case of a tracheal rupture following the use of a Sengstaken-Blakemore tube to control a gastroesophageal hemorrhage. Emergency surgical repair was required. Although complications associated with balloon tamponade are well-documented, no major tracheal injury has ever been reported.

Aged↗
PubMed1994

[Tracheobronchial healing after lung and heart-lung transplantations. Apropos of 64 anastomoses].

The authors report an analysis concerning the healing of tracheo-bronchial anastomoses after lung- and heart-lung transplantation. The present study includes 64 anastomoses selected from a total of 80 cases. Sixteen had to be excluded because of early post-operative death; none of these deaths was related to an air-way complication. Bronchial healing was assessed by bronchoscopic follow-up; the appearance of the suture-line was classified according to Couraud's grades. The initial reference was the examination at 2 weeks, which was compared to subsequent follow-up. At the initial assessment, 42 anastomoses were grade 1, 4 were grade II, and 18 were grade III. The subsequent anatomic result was satisfactory for 52 sutures (81%). The complications were malacia in 2 cases, stenoses treated with a stenting device in 4 cases, dehiscence in 6 cases. The duration of ischemia and postoperative mechanical respiratory support, as well as the proximal or distal site of the anastomosis appeared to be of significant prognostic value.

Adolescent↗
PubMed1993

[Esophageal prostheses in cancer stenosis. Insertion with the Dumon-Gilliard device. 342 patients].

Endoscopic placement of an oesophageal prosthesis rapidly brings a satisfactory comfort to patients with cancer of the oesophagus beyond the therapeutic stage. When the least traumatic technique and materiel are used, the procedure is simple and safe, irrespective of the patient's general condition and the extent of local or regional lesions. The present possibility to insert, at the same time, a tracheobronchial prosthesis broadens the indication to patients who have an oesophagus-airway fistula or who suffer from compression of the trachea or the left bronchus. The procedure is performed under general anaesthesia at the expense of a short hospital stay which is always appreciated by this type of patients. The author's 10-year experience of oesophageal prosthesis placement with the Dumon-Gilliard applicator, is reported.

Adult↗
PubMed1993

[Lung transplantation. Contraindications and new indications].

The authors review the recent changes observed in the indications for lung transplantation. Several classical contra-indications have been alleviated or even cancelled. Chronic infection presenting as cystic fibrosis has become one of the first indications for lung replacement. Respirator-dependent patients are at an operative risk comparable to the overall results. Long-term corticosteroid therapy and pleural adhesions are no longer formal contraindications but should be approached with extreme caution. In recent years, single lung transplantation has been extended to diseases, such as emphysema and pulmonary hypertension, which were formerly indications for double-lung or heart-lung transplantation. The reasons for this include donor shortage and the better 1-year survival following single lung transplantation. The most recent development is paediatric lung transplantation. The legitimacy of redo transplantation is controversial.

Adolescent↗
PubMed1993

Double-lung transplantation in mechanically ventilated patients with cystic fibrosis.

Many lung transplant programs consider ventilator dependence as a contraindication for transplantation. Among 54 patients in whom bilateral lung transplantations for cystic fibrosis were performed by the Joint Marseille-Montreal Lung Transplant Program, 10 were ventilator dependent. Three of them died in the early postoperative period (30%): 2 as a result of cerebral anoxia and sepsis, 1 of Pseudomonas cepacia pneumonia. Two patients died at 15 and 19 months after transplantation of obliterative bronchiolitis and secondary bacterial pneumonitis. Another 2 patients in whom obliterative bronchiolitis developed underwent retransplantation with a heart-lung block; 1 of those was operated on at 12 months and is well at 29 months after his initial transplantation; the second was operated on at 34 months and died of primary graft failure. Three other patients are alive and well at 3, 11, and 14 months after transplantation. Actuarial survival at 1 year was 70%. The postoperative course and the infectious and rejection complications were no different from those in patients who underwent transplantation while spontaneously breathing. Obliterative bronchiolitis developed in 66% of patients at risk (2 of 6 patients surviving more than 6 months). We conclude that transplantation in mechanically ventilated patients with cystic fibrosis is not associated with an increase in morbidity or mortality after bilateral lung transplantation. Long-term survival, as in patients who undergo transplantation while spontaneously breathing, is limited by the development of obliterative bronchiolitis.

Adolescent↗
PubMed1993

Double-lung transplantation in children: a report of 20 cases. The Joint Marseille-Montréal Lung Transplant Program.

In the last 3 1/2 years, we have performed 20 double-lung transplantations in children between 7 and 16 years old (mean age, 13 years). One patient had primitive bronchiolitis obliterans and the other 19, cystic fibrosis. Eight patients were operated on in an emergency situation, 7 of them requiring ventilator support before transplantation. The procedures were en bloc double-lung transplantation in the first 11 patients with separate bronchial anastomoses in 10, and sequential bilateral lung transplantation in the later 9 patients. There were no operative deaths. Two patients died in the hospital on postoperative days 37 and 73, and there were four late deaths, which were due to infection, rejection, and bronchiolitis obliterans. The acceptable incidence of airway complications, the improvement in lung function of survivors, and the acceptable midterm survival make double-lung transplantation an acceptable alternative to heart-lung transplantation in children. However, in very small children, heart-lung transplantation may be preferable because of the size of the airway anastomoses at risk.

Adolescent↗
PubMed1993

Is lung cancer resection justified in patients aged over 70 years?

From January 1980 through January 1985, 452 consecutive patients underwent pulmonary resection for primary non-small cell bronchogenic cancer. Forty-seven patients (10.4%) were 70 years old or older: there were 45 men and 2 women, with a mean age of 72.4 years (S.D.: 2.6; range: 70-79). This population was comparable to the 405 younger patients with respect to the type of resection, histology and TNM staging. Whereas the non-fatal complication rate was similar in both groups (25.5% versus 29.9%), the in-hospital mortality rate was significantly higher in the older patients (12.8% versus 4.7%; P < or = 0.05). The mortality rate after extended resections was significantly higher among the older patients (33.3% versus 6%, P < or = 0.01). The cause of death was myocardial infarction in half the cases; the underlying coronary disease was unrecognized preoperatively in one-third. Five-year survival was comparable in both groups: 29.8% and 33%, respectively. We conclude that pulmonary resection for bronchogenic cancer is justified in patients over 70 years; a careful preoperative assessment ought to be performed and standard resections should be preferred.

Adult↗
PubMed1993

Tracheobronchial healing after lung and heart-lung transplantation. A critical review of 64 anastomoses. The Joint Marseille-Montréal Lung Transplant Program.

The authors report on an analysis concerning the healing of tracheobronchial anastomoses after lung and heart-lung transplantation. The present study includes 64 anastomoses selected from a total of 80. Sixteen were excluded because of early postoperative death; none of these deaths was related to an airway complication. Bronchial healing was assessed with bronchoscopic follow-up; the aspect of the suture line was classified according to the grades of Couraud. The initial reference was the examination at 2 weeks postoperatively, which was compared to subsequent follow-ups. At the initial assessment, 42 anastomoses were grade I, 4 were grade II, and 18 were grade III. The subsequent anatomic result was satisfactory for 52 sutures (81%). The complications observed in the remaining patients were malacia in 2, stenosis treated with a stenting device in 4 and dehiscence in 6. The duration of ischemia and postoperative mechanical respiratory support, as well as the proximal or distal location of the anastomosis appeared to be of significant prognostic value.

Adolescent↗