Biomedical subjects
Publications and source records attributed to T Lerut.
Between 1980-1984 a total of 40 female patients underwent excision of a radiologically diagnosed non-palpable breast tumor. The lesion was malignant in 42,9% (18 patients); 12 specimens showed invasive carcinoma and 6 carcinoma "in situ". "Clustered" microcalcifications were highly suggestive of a malignant lesion. The technique of surgical excision is simple, reliable, surgically not demanding and readily acceptable to the patient.
Between 1978 and 1983 a total of 62 Linton procedures were performed in 53 patients. The results are presented. 62% suffered from an insufficient superficial venous system for longer than 10 years. 34% had an active ulcer at the time of operation. Pre-operative preparation and operative technique are extensively dealt with. Post-operative wound necrosis occurred in 22.5%. This was mainly due to extensive subcutaneous dissection and tissue removal. Recurrent ulcer occurred in 4.8%.
The surgery of carcinoma of the esophagus has undoubtedly made an enormous progress during the last thirty years. This progress is particularly due to advances in anesthesia, resuscitation, postoperative care but in a larger part to the development of new techniques. Our own experience shows indeed that the Belsey approach is a favorable technique. In our opinion this approach is the base of significant increase in resection possibilities. Moreover, it permits a maximal extension of the resection and gives better prospects of reconstruction, with an acceptable mortality. For the patient, for whom no resection is possible, a bypass procedure can still be performed. this solution is preferred to the introduction of a tube, which is bad procedure with a mediocre quality of survival.
During a 4-year period, the authors performed 621 operations on 606 patients, suffering from carcinoma of the breast. The types of operations and their indications are described. Early postoperative complications of all kind appeared in only 6%, while lymphorrhoea and lymphocele were noted in 30% of the cases. Systematic measurements for early arm swelling indicate a fifty-fifty range. Follow-up study on 379 patients reveals the minor incidence of 8,9% of chronic lymphoedema. No statistic relationship between early swelling of the arm and chronic lymphoedema can be recognized.
Myasthenia gravis is an autoimmundisease characterized by muscle fatigability due to a reduction in available acetylcholinereceptors at neuromuscular junction. Although the role of the thymus in the pathophysiology remains obscure, the results of thymectomy are out of discussion. However, controversy continues concerning the indications for thymectomy. In a period of six years and a half, 24 patients underwent a thymectomy. 22 of the patients benefited from the procedure. Their was no relation with sex, age, and severity of the disease; but how sooner we operate, how greater the changes for a total remission. With this results we propose thymectomy as essential in the treatment of myasthenia gravis. We found no relationship between anatomopathological results and these of the thymectomy. But we can confirm that a reduction in the acetylcholine antibodies titer is not essential for clinical benefit.
In 277 consecutive renal transplantations, 49 of 254 patients (19%) developed a gastrointestinal complication causing a mortality rate of 29% (14/49 patients). Oesophageal, gastro-duodenal, pancreatic and ileocolonic complications are reviewed and discussed. Acute gastro-duodenal ulcerations proved to be the most common problem (45--22/49 patients). The loss of allograft in this group of 22 patients was 42% (9/22 patients). To overcome their high mortality (27%--6/22 patients) efforts were made to prevent these complications. After introduction of prophylactic surgery, mortality dropped from 4 to 2%, after systematic long-term prophylactic use of cimetidine, mortality even dropped to 0%. In this last series of 52 patients only one bleeding ulcer was seen immediately after allograft nephrectomy. Ileocolonic complications in renal transplant patients, difficult to diagnose and treat, are associated with a high morbidity and lethality. In 6 patients with colonic complications, 4 could be saved by early and aggressive surgery (67% survival rate). Two recipients developed a de novo gastrointestinal malignancy. Early, accurate, diagnosis and surgical therapy of gastro-intestinal complications after renal transplantation are directly related to the graft and/or patient survival rate. Every effort is therefore necessary to prevent these complications.
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One hundred and twenty-six cases of esophageal atresia from two important centers of Belgium were gathered and subdivided into two groups. Group I ranges from 1969 to 1974 and group II from 1975 to 1980. There was an increase of the postoperative survival rate from 70% to 91%. Nevertheless, a great number of patients die in the late postoperative period (10%), mainly due to the associated cardiac pathology. Thus, the final survival rate is much smaller: 72% in group I, 77% in group II. The basic principles of diagnostic approach, the preoperative as well as the operative strategy are the same in both centers. Secondary interventions, however, are different in these two centers, but the coloplasty as well as the Howard technique have given excellent results. Eleven patients presented the isolated H-shaped tracheo-esophageal fistula. This group was treated separately because of the excellent results of treatment (100% survival).
Diaphragmatic relaxation is either congenital, due to muscular dysplasia ("eventration"), or acquired and related to phrenic nerve lesion ("paralysis"); phrenic nerve paralysis can be a complication of a difficult delivery (breech presentation or forceps) or of a surgical--mostly cardiac--procedure. The authors review their own experience (12 eventrations and 9 paralysis) and recall the pathophysiology, the symptoms and treatment of this condition. They recommend the surgical plication, as most experienced authors do, when the symptoms are not completely alleviated by medical treatment which should be of short duration and must include intubation and assisted ventilation in case of acute respiratory distress.
The authors present a study of 242 patients with breast cancer who were submitted to an axillary radical lymph node dissection between July 1977 and December 1978. The operative indication and the histological results are noted. The operative technique, the postoperative status, complications and the later evolution are extensively described. The axillary lymph node dissection has a prognostic value. A careful operative and postoperative treatment is necessary in obtaining good results, good functional recuperation, and to avoid lymphoedema.
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Lung transplantation nowadays has become a therapeutic modality in the treatment of patients with a variety of end-stage lung diseases. Between July 1991 and December 1992, twelve patients received an isolated lung transplant (eight single lungs and four double lungs) at the University Hospitals of Leuven. The indication for transplantation was emphysema in five patients, pulmonary fibrosis in three, cystic fibrosis in three and primary pulmonary hypertension in one. There were four early, in-hospital deaths (30%): two from sepsis and multi-organ failure, one from anoxia following a bronchial dehiscence and another patient exsanguinated following stent insertion for a partial bronchial dehiscence. Three more patients have died during follow-up: two from chronic respiratory failure secondary to the development of obliterative bronchiolitis (one at 8 months and one at 17 months), and one from a late bronchovascular fistula 4 months following transplantation. The overall actuarial one and two year-survival was 50.0% and 41.6% respectively. All patients discharged from hospital were oxygen free with an improved lung function and exercise capacity. We conclude that lung transplantation is a viable therapeutic option for selected patients with end-stage, irreversible lung disease. In our experience, the bronchial anastomosis remains an important keystone in the early success. Lung transplantation provides a good quality of life in patients free from infection and rejection. Nevertheless, chronic rejection resulting in obliterative bronchiolitis is a major problem in long-term survivors.
A standard posterolateral thoracotomy with division of the latissimus dorsi and serratus anterior muscles is associated with an important postoperative morbidity. A vertical axillary thoracotomy combining a vertical axillary skin incision with an intermuscular approach sparing both latissimus dorsi and serratus anterior muscles has the advantage of allowing full shoulder girdle motion early postoperatively as well as masking of the scar by the upper arm at rest. We report our experience with nine patients operated on with this approach for various intrathoracic lesions. All procedures were carried out without major difficulties. Wound healing was excellent in all patients. No infection nor seroma formation was seen with a submuscular suction drain. All patients had early and full shoulder girdle movement. No patient complained of late post-thoracotomy pain. We conclude that a vertical axillary thoracotomy provides an excellent cosmetic and muscle sparing incision which can be utilized for many thoracic procedures. However, we believe that, in the near future, video-assisted thoracoscopic surgery will become more popular than open thoracotomy for certain indications because of its distinct advantages of less postoperative morbidity.