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Biomedical subjects

T Lerut

Publications and source records attributed to T Lerut.

At least 91 records · Page 5Linked to original sources
PubMed1992

Surgical strategies in esophageal carcinoma with emphasis on radical lymphadenectomy.

From 1975 through 1988, 257 patients with carcinoma of the thoracic esophagus have been treated in our department. Operability was 90% (232/257); overall resectability, 77% (198/257), and for the operated group, 85% (198/232). Hospital mortality rate was 9.6% but decreased to 3% over the period 1986 to 1988. There were 65% squamous cell epitheliomas and 35% adenocarcinomas. Tumor, nodes, and metastases (pTNM) staging was as follows: stage I, 11.6%; stage II, 23.2%; stage III, 37.9%; stage IV, 27.3%. Overall survival rate was 62.5% at 1 year, 42.4% at 2 years, and 30% at 5 years. According to the pTNM staging, 5-year survival was 90% for stage I, 56% for stage II, 15.3% for stage III, and 0 for stage IV. There were no statistically significant differences according to tumor localization, pathologic type, sex, or age. Introducing extensive resection and extended lymphadenectomy seems to improve significantly survival in patients in whom an operation with curative intention was performed, the 1 year survival rate being 90.8% versus 72%; 2-year survival, 81% versus 46%; and 5-year survival, 48.5% versus 41% for radical and nonradical resections, respectively. Based on multivariate Cox regression analysis, only TNM stage and presence or absence of lymph nodes are important factors in predicting survival: stage 1 tumors have lower risk, and involvement of lymph nodes creates higher risk. Using this analysis, there was only for the patients with involved lymph nodes (N1) a significantly better prognosis when a radical lymph node dissection was performed (p = 0.0055). Barrett adenocarcinomas have no worse prognosis than other esophageal carcinomas, with a 5-year survival rate of 91.5% if lymph nodes are negative, and a 54% overall 5-year survival rate. Functional results after restoration of continuity with gastric tubulation were judged excellent to very good in 86.5% at 1 year, but infra-aortic anastomoses have a much higher incidence of peptic esophagitis: 53% versus 8% for cervical anastomoses. From this study it can be concluded that in experienced hands surgery today offers the best chances for optimal staging, potential cure, and prolonged high-quality palliation.

Adenocarcinoma↗
PubMed1992

[Surgery of esophageal cancer].

From 1975 through 1988, 257 patients with carcinoma of the thoracic oesophagus have been treated in our department. Operability was 90% (232/257), overall resectability 77% (198/257) and for the operated group 85% (198/232). Hospital mortality was 9.6% but decreased to 3% over the period 1986-1988. There were 65% squamous cell epitheliomas and 35% adenocarcinomas. pTNM staging was as follows: Stage I: 11.6%, Stage II: 23.2%; Stage III: 37.9%; Stage IV: 27.3%. Overall survival was 62.5% after one year, 42.4% after 2 years and 30% after 5 years. According to the pTNM staging 5-year survival was 90% for stage I, 56% for stage II, 15.3% for stage III. There was no 5-year survival for patients with stage IV carcinoma. There were statistically significant differences according to tumour localisation, pathologic type, sex and age. Introducing extensive resection and extended lymphadenectomy seems to improve significantly survival in patients in whom an operation with curative intention was performed. The 1-year survival was 90.8 versus 72%, 2-year survival was 81 versus 46% and 5-year survival was 48.5 versus 41% for respectively radical and non-radical resections. Radical surgery in stage IV carcinoma substantially prolonged median survival from 6 months to 1 year. From this study it can be concluded that in experienced hands, surgery today offers the best chances for optimal staging, potential cure and prolonged high-quality palliation.

Actuarial Analysis↗
PubMed1992

Randomized clinical trial to assess the value of breast-conserving therapy in stage I and II breast cancer, EORTC 10801 trial.

In a prospective randomized clinical trial conducted by the European Organization for Research and Treatment of Cancer (EORTC), mastectomy was compared with breast-conserving therapy in 903 stage I and stage II breast cancer patients entering the study between 1980 and 1986. The main participating centers were: Guy's Hospital, London; The Netherlands Cancer Institute, Amsterdam; University Hospital, Leuven; Radiotherapy Institute, Rotterdam; Breast Unit, Tijgerberg, S.A. The data were collected in the EORTC Data Center, Brussels. Treatment in the study arm consisted of lumpectomy, axillary clearance, and radiotherapy to the breast (50 Gy external irradiation in 5 weeks followed by boost with iridium implant of 25 Gy). Important in this study is the large number of TNM stage II patients (755). Most patients were stage II because of the size of the tumor (2-5 cm). The patient and tumor characteristics in the study and control groups were well balanced. So far the survival curves and local recurrence rates are not statistically different for the two study arms. Tumor size was found in univariate analysis to be a significant risk factor for local recurrence in the breast-conserving therapy group but not in the mastectomy group. Results of salvage treatment for local recurrence were not better for the breast-conserving therapy group compared with the mastectomy group. Measurements of quality of life and cosmesis show a clear benefit for the breast-conserving therapy group.

Adult↗
PubMed1992

Zenker's diverticulum: is a myotomy of the cricopharyngeus useful? How long should it be?

In a series of 100 consecutive patients surgically treated for Zenker's diverticulum (ZD) biopsy specimens were taken at the level of the cricopharyngeal muscle in 62 patients and also at the level of the striated muscle wall of the cervical esophagus in 10 patients. Contractility, pathological enzymo- and immunohistochemical characteristics were studied in comparison with a group of 15 controls. Obvious pathological findings were noted in 95% of the ZD specimens as compared with the control specimens. These pathological changes, although somewhat less pronounced, were also documented in the biopsy specimens taken at the level of the striated cervical muscle wall. The findings were judged important enough to justify a long extramucosal myotomy of the cricopharyngeal muscle and cervical esophagus as an essential step in the treatment of ZD. The treatment of choice in this series was a diverticulopexy and a four to five centimeter long extramucosal myotomy, starting from the cricopharyngeal muscle and extending downwards into the striated muscle wall of the cervical esophagus. Excellent or very good results were obtained in 96% of the patients with respect to diverticulum-related symptoms.

Adult↗
PubMed1991

Surgery for esophageal carcinoma.

From 1975 through 1988, 257 patients with carcinoma of the thoracic esophagus have been treated in our Department. Operability was 90% (232/257), overall resectability 77% (198/257) and for the operated group 85% (198/232). Hospital mortality was 9.6% but decreased to 3% over the period 1986-1988. There were 65% squamous cell epitheliomas and 35% adenocarcinomas. pTNM staging was as follows: Stage I: 11.6%; Stage II: 23.2%; Stage III: 37.9%; Stage IV: 27.3%. Overall survival was 62.5% at 1 year, 42.4% at 2 year and 30% at 5 year. According to the pTNM staging 5-year survival was 90% for Stage I, 56% for Stage II, 15.3% for Stage III and 0 for Stage IV. There were no statistically significant differences according to tumor localisation, pathologic type, sex, age. Introducing extensive resection and extended lymphadenectomy seems to improve significantly survival in the patients in whom an operation with curative intention was performed, the 1-year survival being 90.8% versus 72%, 2-year survival: 81% versus 46%, and 5-year survival 48.5% versus 41% for respectively radical and non radical resections. Barrett adenocarcinomas have no worse prognosis than other esophageal carcinomas with a 5-year survival of 91.5% if lymphnodes negative, and a 54% overall 5-year survival. Functional results after restoration of continuity with gastric tubulation were judged excellent to very good in 86.5% at 1 year, but infra-aortic anastomoses have a much higher incidence of peptic esophagitis: 53% versus 8% for cervical anastomoses. From this study it can be concluded that in experienced hands surgery today offers the best chances for optimal staging, potential cure, and prolonged high quality palliation.

Adult↗
PubMed1991

Conventional X-ray examination in esophageal cancer: an opinion.

Double contrast is the best radiological technique for the detection of small esophageal cancer. Gastrografin is indicated when a blind mediastinal fistula is suspected; in cases of choking or suspicion of a fistula with the airways, a low osmotic hydrosoluble Iodium compound must be used. Conventional radiology and endoscopy are complementary techniques for the detection of esophageal cancer, as some lesions may be missed or misinterpreted by both. The need for endoscopic biopsy being incontestable for diagnostic confirmation and characterization, radiology presents some advantages over classic esophagoscopy for preoperative and the general pretherapeutic staging of esophageal carcinoma: assessment of topographical relation with the surrounding organs is possible and with the upper esophageal sphincter is easier; appreciation of tumoral extension along the longitudinal axis (tumor length, gastric invasion) remains mostly possible even in cases of severe stenosis; tumoral extension along the transverse axis (kinking, fistula) may be evaluated; detection of a second tumor or concomitant pathology distally from a stenosing tumor is mostly possible; moreover radiology is important before starting radiotherapy; and finally, previous radiology may reduce the (small) risk of endoscopic perforation. Radiology is indispensable or indicated in the posttherapeutic follow-up of esophageal carcinoma, as well after surgery as after endoscopic interventions, radiotherapy or chemotherapy.

Diatrizoate Meglumine↗
PubMed1990

Percutaneous transhepatic venous sampling of the pancreas in localizing insulinomas.

Fourteen percutaneous transhepatic venous samplings of the pancreas were performed in 13 patients. Ten patients undergoing 11 samplings were operated, while 3 patients were not operated. Surgical intervention disclosed a single tumor in 8 patients, a double tumor in 1 patient and diffuse hyperplasia in 1 patient. The method allowed correct localization of 5 insulinomas and correct regionalizing of 4 insulinomas in 9 of 10 small tumoral lesions. In 1 double localization of the pancreatic body percutaneous venous sampling only detected 1 lesion. In 1 case of diffuse hyperplasia of the pancreatic tail, the venous sampling was suggestive for a tumor in the pancreatic tail. The method appears to be highly accurate in diagnosing and localizing insulinomas of the pancreas. However, a need persists for 3-dimensional localization of the lesions to facilitate enucleation. Intraoperative ultrasound could become the method of choice for localization of insulinomas.

Adult↗
PubMed1989

Primary malignant fibrous histiocytoma of the esophagus.

A 59-year-old man was admitted to the hospital for dysphagia and fever. Esophagogram and upper gastrointestinal endoscopy revealed a polypoid mass in the midesophagus. Subtotal esophagectomy, cervical esophagogastrostomy, and lymph node dissection were performed. The histological diagnosis of the tumor was malignant fibrous histiocytoma. An area of severe epithelial dysplasia was found in the esophageal mucosa 3 cm under the tumor.

Esophageal Neoplasms↗
PubMed1989

Cosmetic evaluation of breast conserving treatment for mammary cancer. 2. A quantitative analysis of the influence of radiation dose, fractionation schedules and surgical treatment techniques on cosmetic results.

The effects of surgical treatment techniques, radiation doses and fraction sizes on cosmetic outcome were analysed in a population of 161 patients with stage I and II breast cancer treated with breast conserving surgery and a wide range of radiotherapy doses. In 142 patients also quantitative measurements of nipple position asymmetries and breast contour retraction were carried out. The scoring and measurement results were analysed using a multivariate model to assess the relative importance of the various factors involved. In this material radiation dose to the breast was the most significant parameter correlated with cosmetic outcome (p = 0.0001). Radiation doses higher than 75 Gy in 37 fractions led to very poor results in more than 30% of patients. For the quantitative measurements of radiation fibrosis, a dose-response curve could be demonstrated over a dose range of 40 to 86 Gy in fraction sizes of 2 Gy. Above 50 Gy, increases in dose of 1 Gy correlated with an average displacement of nipple and breast contour of 1 mm, in upward direction and of 0.75 mm to the median. An increased amount of fibrosis was observed when part of the treatment was given in larger fraction sizes (4-6 Gy). Plotting the data against dose equivalent TE values, an alpha/beta value of 2.5 Gy could be estimated for the development of late fibrosis. Other treatment factors whose influence on cosmetic outcome could be identified and quantified were the differences in surgical techniques for the removal of the primary tumor (tumorectomy vs. segmentectomy, p = 0.05) and for the axillary clearance ("en bloc" dissection vs. separate incisions, p = 0.018). Also technical aspects of the radiotherapy on the regional lymph nodes, sometimes leading to matchline fibrosis, proved to be important (p = 0.0075). Finally, a number of tumor-related factors were assessed in order to take their relative importance into account, if necessary, when studying therapy factors. While tumor stage had only a limited impact in the range of tumors included in this study, the localisation of the tumor significantly influenced cosmetic outcome with worse results for inferior and medial localisations. While quantitative measurements were not correlated with all the factors identified for poor cosmesis, their great value is to quantify the radiation-induced fibrosis as well as the effects of different surgical techniques on nipple retraction.

Breast↗
PubMed1989

Propofol does not inhibit hypoxic pulmonary vasoconstriction in humans.

The influence of increasing doses of propofol (from 6 to 12 mg/kg/h by continuous infusion) on hypoxic pulmonary vasoconstriction was studied in 10 patients prior to thoracic surgery. All patients were intubated with a left-sided double-lumen endobronchial tube. Initial anesthesia and muscle relaxation were accomplished by administering fentanyl, droperidol, and pancuronium. After 100% oxygen ventilation of both lungs for 20 min in a lateral decubitus position, the nondependent lung was deflated and one-lung ventilation was started. The dependent lung was continuously ventilated with 100% oxygen. Twenty minutes after the start of one-lung ventilation, propofol at an IV infusion rate of 6 mg/kg/h was added to the anesthetic technique. Thirty minutes later it was increased to 10 mg/kg/h and another 15 min later to 12 mg/kg/h. Then the propofol infusion was stopped. Thirty minutes later, two-lung ventilation was restarted to compare initial values. No changes in venous admixture or PaO2 were observed during propofol infusion. There was no change in any respiratory or circulatory variables except systemic vascular resistance, which decreased significantly immediately after the propofol infusion commenced but returned to control values 15 min later for the rest of the observation period. After reestablishing two-lung ventilation, all variables did not differ from control values. In all patients, the hypoxic pulmonary vasoconstriction reflex was present after institution of one-lung ventilation and was not abolished after administration of propofol in doses from 6 to 12 mg/kg/h.

Aged↗
PubMed1988

Renal cadaveric transplantation in diabetics using total lymphoid irradiation or cyclosporin A. A controlled randomized study. Leuven Collaborative Transplantation Group.

A total of 20 renal transplant patients with end-stage diabetic nephropathy entered a randomized controlled trial comparing preoperative, fractionated total lymphoid irradiation (TLI) (radiation dose, 20-30 Gy) with postoperative cyclosporin A (CsA). Both groups received postoperative low-dose methylprednisolone maintenance therapy. The 3-year patient and graft survival was similar for both groups (100% and 71% in the TLI and 75% and 75% in the CsA group, respectively). Rejection crises occurred significantly more frequently (P less than 0.01) in the TLI-treated recipients. The incidence of infectious or diabetic complications was not significantly different in both groups. It is concluded that TLI and CsA are both effective treatment modalities for cadaveric renal transplantation in diabetics; CsA, however, is superior in preventing rejection crises.

Adult↗
PubMed1988

Shortage of kidneys, a solvable problem? The Leuven experience. Leuven Collaborative Group for Transplantation.

Our 10-year experience with the LCGT indicates that close collaboration of nephrologists from peripheral centers for the long-term follow-up of transplanted patients presented no obstacles to excellent patient and graft survival rates. At the same time, "decentralization" greatly increased the motivation of collaborating centers to participate in organ procurement. In addition, the introduction of an "opting out" law provided spectacular stimulation for collaborating center participation. For the first time in many years, the number of transplants was higher than the number of new candidates registered on the waiting list.

Actuarial Analysis↗
PubMed1987

Immunological and clinical observations in diabetic kidney graft recipients pretreated with total-lymphoid irradiation.

In a feasibility study, twenty patients with end-stage diabetic nephropathy were treated with fractionated total-lymphoid irradiation (TLI, mean dose 25 Gy), before transplantation of a first cadaveric kidney. During radiotherapy, only one patient had a serious side effect (bone marrow depression). After transplantation four patients died (one of a myocardial infarction, one of ketoacidosis, and two of infections occurring during treatment of rejection crises). One graft was lost because of chronic rejection. The other 15 patients have a functioning graft (mean follow-up 24 months) and receive low-dose prednisone alone (less than 10 mg/day, n = 11) or in conjunction with cyclosporine (n = 4) as maintenance immunosuppressive therapy. A favorable clinical outcome after TLI (no, or only one, steroid-sensitive rejection crisis) was significantly correlated with a high pre-TLI helper/suppressor lymphocyte ratio, a short interval between TLI and the time of transplantation, and the occurrence of functional suppressor cells early after TLI. The most striking immunological changes provoked by TLI consisted of a long-term depression of the mixed lymphocyte reaction and of the phytohemagglutinin, and Concanavalin A or pokeweed-mitogen-induced blastogenesis. A rapid and complete recovery of the natural killer cell activity was observed after TLI. A permanent inversion of the OKT4+ (T helper/inducer) over OKT8+ (T suppressor/cytotoxic) lymphocyte ratio was provoked by a decrease of the OTK4+ subpopulation, together with a supranormal recovery of the OKT8+ lymphocytes. A majority of the latter lymphocytes did also express the Leu 7 and the Leu 15 phenotype.

Adult↗