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Biomedical subjects

A P Naef

Publications and source records attributed to A P Naef.

14 recordsLinked to original sources
PubMed1979

[Surgery of bronchial neoplasms].

Surgical resection is the most efficient therapy for lung cancer. Preoperative investigation should determine histology, local invasion and distant dissemination. Tumor-host relation (immunocompetence and tumor burden) is essential for long-term results. Relatively crude anatomical staging does not take biological parameters into account, and any case with lympho-glandular involvement (N1) should not be considered as stage I carcinoma. 520 cases treated by pulmonary resection are reviewed and common denominators for long-term survivors determined. Stage I epidermoid carcinoma treated by lobectomy or left pneumonectomy with a short history (survey cases) are the ideal candidates for surgical resection. The importance of early diagnosis by routine screening is stressed.

Bronchial Neoplasms↗
PubMed1979

[Federation of Swiss Physicians and the training of general surgeons].

The author recommends the Residency Program of the Halsted type as developed by D.C. SABISTON in the Departement of Surgery at Duke University. A two-year training in the basic problems, knowledge, and attitudes, common to all surgical subspecialties, is of fundamental importance (Fig. 1). The goal of this type of training is the US-Board Certification.--The Swiss Medical Federation considers the following factors as essential in a surgical training programm: The training of the general surgeon should be geared to broad principles without early overspecialisation. The training should allow a certain flexibility for the teacher as well as the candidate. A sufficient operative experience is paramount as well as the habit of a continuous education all trough a life-long surgical career and an understanding for economy in surgical practice.--The training of an university--or a private--surgeon does not give rise to important problems, whereas the training of surgeons for the medium sized and small Swiss hospitals represents a difficult problem. A double training in "visceral" and "orthopaedic" surgery with an accent on one or the other seems necessary in order to have one chief surgeon take the place of another during vacation, week-ends and illness. Even if such a complete training seems desirable, it can be justly questioned if under the present circumstances (emergency transportation, regionalized hospital organization, specialized hospital consultants) it is still justified to aim at the training of a "complete" surgeon who elsewhere, in a university hospital or in private practice or for that matter in other countries, is no longer absolutely necessary.

Certification↗
PubMed1977

[Bronchial adenoma].

Twenty-four patients with bronchial adenoma seen over a 20-year period are reviewed. Follow-up data was available in all patients. They included 19 with carcinoid, 2 with adenoid-cystic carcinoma, and 3 with muco-epidermoid carcinoma. Recurrent pulmonary infection, cough and hemoptysis were the most common clinical manifestations. Surgical resection was performed in all but one patient, who was treated by irradiation; bronchoplastic and conservative resectional procedures were used in 5 patients with carcinoid adenoma. Carcinoid tumors are considered to be very slowly-growing malignant neoplasms that sometimes give rise to metastases to regional lymph nodes. Such metastases were present in only one patient. All patients are alive and well. Adenoid-cystic carcinoma is a more aggressive tumor with a tendency to recur. Much of the difficulty in its treatment is due to its close proximity to the bifurcation of the trachea. One patient was operated upon three times for local recurrences and ultimately died from respiratory failure after the third operation. The other patient received radiation therapy with cobalt and is well, without recurrence, 3 years after the treatment. The 3 muco-epidermoid carcinomas were histologically similar to such tumors of salivary glands but behaved clinically like highly malignant tumors, no patients surviving 8 months after resection. The term bronchial adenoma is a misnomer. The neoplasms grouped under this heading should be called carcinoid adenoma, adenoid-cystic carcinoma, and muco-epidermoid carcinoma and considered as separate entities, since the ultimate course and prognosis is definitely different.

Adenoma↗
PubMed1977

Amyloid pseudotumor treated by tracheal resection.

Primary amyloidosis is a rare disease, and even more so when it appears as a tumorlike formation in the lung or tracheobronchial tree. On rare occasions it has been treated by pulmonary resection but never before by tracheal or bronchial sleeve resection. A case of tracheal sleeve resection for tumorlike amyloidosis is reported. If the lesion is well circumscribed to a relatively short tracheal or bronchial segment, sleeve resection appears to be a satisfactory and economical solution. However, the problem of a mucosa undermined by amyloid deposits above and below the tumorlike lesion entails the risk of anastomotic stenosis. For this reason in future cases, particularly those with extensive involvement, piecemeal endoscopic removal should be considered as the method offering the best prognosis and least risk.

Adult↗
PubMed1977

[3 cases of mucoepidermoid bronchial malignant tumors].

Mucoepidermoid tumors of the lung are extremely uncommon. Like the considerably more common mucoepidermoid tumors of the salivary glands, their histology is characterized by two components: a glandular mucoid element and an epidermoid element. The degree of malignancy is still a subject of discussion, but as with mucoepidermoid tumors of the salivary glands, mucoepidermoid carcinomas of the bronchus may be of either high or low-grade malignancy. The three cases reported here were of high-grade malignancy and metastasized irrespective of the degree of cellular differenciation. We have concluded that mucoepidermoid lung tumors should be considered as malignant lesions and the treatment has to consist in radical resection.

Bronchial Neoplasms↗
PubMed1976

The surgical treatment of pectus excavatum: an experience with 90 operations.

Funnel chest, a congenital hereditary deformity, may lead to impairment of cardiopulmonary function. The predominant motives for operation are psychological and cosmetic. Patients with minor deformities amenable to physiotherapy should not be operated upon, but moderately severe defects justify surgical intervention. Objective photographic documentation is essential. Because of their importance to surgical technique and results, the symmetrical, asymmetrical, localized, and extensive deformities should be distinguished. Ninety operations were performed between 1951 and 1974 according to the various techniques known during that period. Results were irregular until the introduction eight years ago of an operation combining extensive resection according to Ravitch and stabilization by a metal strut as recommended by Adkins and others. Of 24 operations performed during the last eight years, 23 have given excellent long-term results.

Adult↗
PubMed1975

[Economical surgery, bronchial or pulmonary, in the treatment of lung cancer].

In the present uncertainty as to the relative importance of maximum radical resection, surgical treatment of bronchial carcinoma should be guided by the state of cardio-pulmonary function and quality of survival. In borderline cases, therefore, consideration should be given to economic resection, either parenchymal or bronchial. Surgery was performed for bronchial carcinoma in 369 cases between 1963 and 1974, involving 30 segmental resections and 26 bronchial sleeve resections. Favourable results are reported for the curative operations, whereas the results of palliative resections show low mortality but unfavourable longterm survival.

Adenocarcinoma↗
PubMed1975

[Surgical treatment of funnel chest. Surgical experience with 90 cases].

Funnel chest, a congenital hereditary deformity, may lead to impairment of cardio-pulmonary function. The predominant motives for operation are psychological and cosmetic. Minor deformities amenable to physiotherapy should not be operated on, but moderately severe one represent a justified surgical indication. Objective photographic documentation is essential. Because of their bearing on surgical technic and results the symmetrical, asymmetrical, localized and extensive deformities should be distinguished. 90 operations have been performed between 1951 and 1974 according to the different known technics published during that period. Results were irregular until the introduction, eight years ago, of an operation combining extensive resection, by the method of RAVITCH, and stabilization by a metal strut as recommended by ADKINS et al. 24 operations performed during the last eight years have afforded perfect long term results.

Adult↗
PubMed1975

[Endobrachyesophagus and adenocarcinoma].

During 6168 esophagoscopies (ENT Clinic, Medical School of Lausanne and Hospital of Yverdon: 1963-1974), 164 cylindrical epithelial patches (26%) have been detected endoscopically with a regular progressive incidence from year to year (optical improvement, interest and progressive training of endoscopists). Endoscopically, a distinction can be drawn between: 1. the cylindrical epithelial islets of the upper (19%) or lower (4%) esophagus; 2. widespread cylindrical epithelial lining of the lower esophagus (77%). The first type cannot be associated in any significant manner with any organic pathology. It is of congenital origin and is, as a rule, without pathological significance. Statistically, however, the second type would seem to enter into the category of peptic esophagitis in its chronic form, and appears to constitute a form of cicatrization. The incidence of adenocarcinoma of the lower esophagus in association with this second form of cylindrical epithelial lining is significant. It would, therefore, be advisable for peptic esophagitis to be treated before it reaches its chronic stage and, in particular, before the appearance of cylindrical epithelial scars.

Adenocarcinoma↗
PubMed1975

Columnar-lined lower esophagus: an acquired lesion with malignant predisposition. Report on 140 cases of Barrett's esophagus with 12 adenocarcinomas.

The analysis of a series of 1,225 cases of reflux esophagitis shows the serious nature of this condition. A liberal use of antireflux operations therefore seems justified. Extensive columnar metaplasia of the distal esophagus, or columnar-lined lower esophagus (CLLE), represents a late irreversible stage of reflux esophagitis. Repeated esophagoscopies demonstrate the acquired nature of the lesion. It is caused by the progressive healing, from below upward, of peptic ulcerations on the squamous epithelium by metaplasia of columnar mucosa. Antireflux operations stop the progressive ascent of heterotopic epithelium and thus stabilize reflux esophagitis and cure complications such as ulcerations and strictures. The premalignant character of this condition is established by a 10 per cent incidence of adenocarcinomas in a series of 140 cases of extensive columnar metaplasia. The transition toward malignancy seems to be irreversible and cannot be arrested by an antireflux operation. Therefore, repeated esophagoscopic controls and biopsies are an absolute necessity in all cases of extensive columnar metaplasia, even after cure of active reflux esophagitis by Nissen fundoplication.

Adenocarcinoma↗