[Role of surgery in the treatment of chronic obstructive pneumopathies].
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Follow-Up Studies↗
Biomedical subjects
B Andreassian
Publications and source records attributed to B Andreassian.
Diagnosis and management of 17 consecutive patients with inflammatory abdominal aortic aneurysm.
This report reviews the authors' experience in diagnosing and managing 17 consecutive patients with inflammatory abdominal aortic aneurysm (AAA). Among 491 patients undergoing repair for AAA during a 10-year period, 17 (3%) had evidence of associated periaortic fibrosis, which was confirmed histologically. No patient had acute rupture, and two patients (12%) had chronic contained rupture. Ureteral obstruction was evident in seven patients. In 41% of the patients, available surgical correlation demonstrated that computed tomographic (CT) scan accurately delineated the extent of the disease. Sixteen patients underwent aneurysm resection. Ureteral obstruction was relieved by ureterolysis in three patients treated early in this series. In the last period of the study, well-documented hydronephrosis spontaneously subsided in two patients without special treatment. Of these 17 patients, 15 (88%) were early (30-day) survivors. There were two late deaths at 2 months and 5 years; 12 (71%) patients are still alive and free of symptoms up to 10 years after operation. On the basis of our study, we conclude the following: (1) precise preoperative diagnosis and detailed anatomic information are widely available with CT; (2) aneurysm resection is the treatment of choice because the risk of rupture still exists, and this procedure seems to reverse the inflammatory process; (3) good early and late results can be expected with proper surgical technique; and (4) routine follow-up with CT is recommended to document resolution or progression of the fibrotic process after aneurysm resection.
Aged↗
Pulmonary lymphangiomyomatosis treated by single lung transplantation.
Pulmonary lymphangiomyomatosis is a rare disease resistant to almost all medical treatments to date. We describe the case of a 44-yr-old woman with end-stage pulmonary lymphangiomyomatosis who was treated by single-lung transplantation. The patient is doing well in her sixteenth post-transplantation month and has a marked improvement in her pulmonary function tests and walking distance as compared with preoperative values, and she is enjoying an unrestricted life-style.
Adult↗
[Arteriovenous fistula following surgery of intervertebral disk].
Vascular damage during intervertebral disc surgery is uncommon. It sometimes leads to the formation of an arteriovenous fistula and about one hundred cases have been reported in the literature. The diagnosis is often early, with signs of venous hypertension predominating. The authors report a case of arteriovenous fistula presenting late as apparently primary congestive cardiac failure. The mechanisms of this condition were demonstrated during preoperative instrumental manoeuvres. Surgical correction is the only treatment alternative. Repair must be arterial and venous, most often using prosthetic material. This generally enables total and permanent recovery, but overall mortality in pathology of this type is not nil.
Adult↗
[Aneurysms of the abdominal aorta with periaortic fibrosis. A retrospective study of 23 consecutive successful operations].
Aneurysms of the abdominal aorta associated with periaortic fibrosis (AFPA) are a different clinicopathological entity from atheromatous aneurysms and nonspecific inflammatory periaortitis. The physiopathology and diagnostic and therapeutic modalities for these AFPAs are controversial. Over a 12-year period, 23 aneurysms with periaortic fibrosis (4%) confirmed by a histological study were operated at Beaujon hospital. Four patients were operated at the rupture stage, 2 with acute rupture and 2 with contained chronic rupture. Uni- or bilateral ureteral obstruction was noted in 8 patients. The diagnosis was suspected preoperatively in 60% of cases. Surgery confirmed the accuracy of the anatomical information provided preoperatively by the CT examination performed in 9 patients. Debridement and grafting were performed in 22 patients. Three patients with associated ureteral obstruction were treated with ureterolysis during the same operative step at the beginning of our experience. Later on, 3 documented cases of hydronephrosis receded after the isolated debridement and grafting of the aneurysm. Hospital mortality was of 5% in 19 patients operated electively. Two patients died later, after 2 months and after 5 years, and 16 are still alive and without symptoms at present, after and average time lapse of 68 months.(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗
Adrenocortical carcinoma in surgically treated patients: a retrospective study on 156 cases by the French Association of Endocrine Surgery.
BACKGROUND: Because of the rarity of adrenocortical carcinoma, survival rates and prognosis for patients who have undergone operation are not well known. The purpose of the French Association of Endocrine Surgery was to evaluate these factors in all patients treated during a 12-year period by its members. METHODS: One hundred fifty-six patients (95 women, 61 men) with a mean age of 47 years were included. Functional symptoms were found in 52% of patients, and hormonal studies revealed secreting tumors in 62% of cases. Ninety-four percent of the patients underwent resection of the adrenal tumor, and 20% of them had extensive resection because of invasive cancers. Complete resection was achieved in 127 patients (81%) and incomplete resection in 29 patients. Mean tumor weight was 714 gm (range, 12 to 4750 gm), and the mean diameter was 12 cm (range, 3 to 30 cm). The results of the tumor staging were stage I, eight patients (5%); stage II (local disease), 75 patients (48%); stage III (locoregional disease), 39 patients (25%); and stage IV (metastases), 34 patients (22%). RESULTS: The 5-year actuarial survival rates were 34% overall, 42% in curative group, 53% in local cancer group, 24% in regional disease group, and 27% in the reoperated group. One-year actuarial survival rate of the palliative group was 9% (median survival, 6 months). Multivariate analysis showed that better prognosis occurred in patients younger than 35 years of age (p = 0.01) and in patients with androgen-secreting tumors, precursor-secreting tumors, or nonsecreting tumors (p = 0.003). Mitotane improved the survival rate only in patients with metastases who received it after operation (vs non-mitotane-treated patients [p < 0.05]). CONCLUSIONS: In this study age, extent of disease, aspect of the surgical resection, and type of hormonal secretion influenced survival.
Adrenal Cortex Neoplasms↗
[Aneurysms of the abdominal aorta. Value and mode of detection].
Despite improvements in the treatment of risk factors for atherosclerosis, the incidence and mortality rate for aneurysms of the abdominal aorta have increased during the past 40 years. The prevalence of these aneurysms is 2.5 percent in unselected populations but reaches 13.5 percent in selected populations. The pathogenesis of aneurysms involves multiple factors and the lesion is progressive, leading to lethal rupture in 25 percent of the cases. In elective surgery of abdominal aortic aneurysms the mortality rate is about 2 percent, as against 60 percent in emergency surgery for rupture. The presence of such aneurysms must be detected primarily in populations at risk, using physical examination and abdominal ultrasonography. If this is done, the ratio of detection costs to benefits of preventive surgery is in favour of a decidedly active approach of this dangerous disease.
Aorta, Abdominal↗
[Reimplantation of a non-functioning lung. Report of a case].
The authors present the case of a patient with a carcinoid tumor of the left main bronchus. Conservative surgery by sleeve resection without pulmonary resection was performed. The underlying lung which was considered to be nonfunctioning during pre-operative evaluations, completely recovered within a year following surgery.
Anastomosis, Surgical↗
[Early prognostic factors of the surgery of aneurysms of the abdominal aorta with renal artery clamping].
The aneurysms of the abdominal aorta requiring suprarenal clamping are rare. Suprarenal clamping was required for only 43 of 544 aneurysms operated electively from 1981 to 1989. Twenty-five patients had a juxtarenal aneurysm, without any normal aortic segment under the renal arteries, and suprarenal clamping was therefore necessary while the upper anastomosis was being established (group I). Eighteen patients had an aneurysm enclosing the root of at least one renal artery (group II). Several prognostic factors have been assessed: patient's age, presence of preoperative renal insufficiency, of arterial hypertension or of coronary insufficiency, and revascularization method. Five patients died. Four of them belonged to group II and were over 75 years old. All presented with a preoperative renal insufficiency. Two of these deaths were caused by mesenteric infarction. Four cases of regressive postoperative renal insufficiency were observed in patients for whom renal clamping had lasted longer than 45 minutes. This study allowed outlining three prognostic factors: the patient's age, preoperative renal insufficiency, a period of renal ischemia exceeding 40 minutes. On the other hand, the severity of hypertension had no predictive value. Coronary insufficiency requires a strict hemodynamic surveillance, but is not a contraindication for revascularization.
Age Factors↗
[Intestinal ischemia after surgery of the infrarenal aorta. Apropos of 13 cases].
Ischemic damage of the gastrointestinal tract following aorto-iliac surgery was estimated in a retrospective study. Between 1984 and 1988, we observed 13 cases of intestinal ischemia from a total of 416 surgical patients (3 per cent): 7 cases of full-thickness necrosis and 6 cases of transient ischemia. They represent 23 per cent of complications in ruptured aneurysmal surgery, 2.8 per cent in elective aneurysmal surgery, and 1.6 per cent in operations for obstructive lesions. All deaths (5/13) followed necrosis. Diarrhea, sometimes bloody, was the main symptom. Its sensitivity was 70 per cent, and its specificity was 98 per cent. Leukocytosis (greater than 10000/mm3), was noted in 70 p. cent of the cases of ischemia. The diagnosis was established by colonoscopy in 7 cases and by surgical examinations in 6 cases. The endoscopic injuries were ulcerations, punctate hemorrhages, and pseudomembranes localized in the sigmoid (77 p. cent), left colon (38 per cent) and small bowel (15 per cent). Of 13 patients, 6 developed intraoperative hypotension. This study confirms the gravity of intestinal ischemia after aortic surgery. In high risk patients (ruptured aortic aneurysm, intraoperative hypotension, postoperative diarrhea) endoscopy offers the possibility of early diagnosis and appropriate treatment.
Aged↗
Clinical use of transbronchial biopsy in single-lung transplantation.
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Azathioprine↗
Single-lung transplantation in pulmonary emphysema.
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Humans↗
False aneurysm infected by Aspergillus fumigatus: an unusual complication of aortofemoral bypass graft.
Two cases of Aspergillus fumigatus infection of aortobifemoral prosthetic grafts are reported. Both patients were treated successfully by excision of the infected prosthetic material, axillofemoral extra-anatomic bypass, and prolonged medical treatment. The patients received amphotericin B, 5-flucytosine and itraconazole until negative aspergillus serology was obtained (at 9 and 18 months, respectively). Later, repeat disobliteration procedures for thrombosis of the axillofemoral bypass were required. No recurrent aspergillus infection was found.
Amphotericin B↗
Mesenteric infarction in Takayasu's disease.
Obstructive lesions of the visceral arteries in Takayasu's disease are common but rarely symptomatic. This report concerns two patients with Takayasu's disease who died of mesenteric infarction due to superior mesenteric artery thrombosis. Prophylactic revascularization of the visceral arteries in Takayasu's disease remains controversial, and lesions can be more severe than classically recognized.
Adolescent↗
Single-lung transplantation in emphysematous patients.
We report six single-lung transplantations in emphysematous patients with end-stage disease. Compression of the graft or ventilation/perfusion imbalance were not observed. Rejection episodes were generally documented through transbronchial biopsies and the radiological changes related to acute infections or rejections were restricted to the transplanted lung. Three patients died from CMV pneumonia, status epilepticus and fibrosis of the graft following bronchography, respectively. The three remaining patients are well, with documented improvement of pulmonary function tests and arterial blood gases. Bronchial complications were observed in all patients and have in some cases required dilatation or insertion of a stent. Although requiring a longer follow up, single transplantation is feasible and beneficial in patients with end-stage emphysema.
Adult↗
Combined lung and heart extraction in clinical transplantation.
The anatomical conditions for single lung and double lung transplantation allow a heart transplant and one or two lung transplants to be performed in two or three different recipients from a single donor with healthy lungs. The extraction of the heart and lung block for the purposes of these separate transplantations is described on the basis of our experience of 6 single lung transplants with 6 extractions for cardiac transplantation in different recipients, of a total of 8 lung transplants. We report these 12 successful operations and the particular technical modalities of cardiopulmonary extraction for separate transplantation. After cannulation for cooling of the abdominal viscera (kidneys, liver, pancreas), thoracic and mediastinal dissection, cardioplegia and surface pulmonary cooling by iced saline on the collapsed lungs, the heart and lungs were extracted as a single block and were separated ex situ. After periods of cold ischaemia of 1 h to 3 h 30 min for the hearts and 1 h 30 min to 5 h for the lungs, the immediate and medium term functions were satisfactory. Logistical difficulties involved in matching the population of recipients have prevented the grafting of three different recipients up until now. These successes make it essential to preserve the lungs from donors with healthy lungs. A rigorous coordination between the various transplantation teams helps to avoid competition between the three types of transplantation: heart-lung, double lung and single lung.
Adolescent↗
Single-lung transplantation in hyperinflated patients.
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Humans↗
Treatment of stage II chronic arterial disease of the lower limbs with the serotonergic antagonist naftidrofuryl: results after 6 months of a controlled, multicenter study.
A study was carried out in patients with intermittent claudication (Fontaine's stage II). The atheromatous origin of the disease was confirmed and localized by angiography or Doppler. One hundred eight-three patients were selected initially (day -30) with a pain-free walking distance on a treadmill (at a speed of 3 km/h and a slope of 10%) ranging from 150 to 300 m. During the first month (washout period) all patients received two placebo tablets daily. At the end of this run-in period (day -30; day 0) and after checking walking distance stability (allowed variation: 20% between the two measurements), patients were included in the study. According to this criterion, 112 patients were selected and 94 remained during the whole study. The study was designed in double-blind, using two parallel, randomly selected groups. Fifty-two patients received naftidrofuryl (2 x 316.5 mg tablets daily with meals) for 6 months; 42 patients received placebo under the same conditions. During this period, clinical and paraclinical examinations were carried out every quarter (day 90 and day 180). After checking the initial homogeneity of the naftidrofuryl and placebo groups, the comparison between the two groups indicates a significant improvement in the naftidrofuryl group after 3 months and 6 months of treatment, for the pain-free walking distance. For the maximal walking distance, a significant improvement was found at day 180. Nonparametric analysis (chi 2 test) also indicated a significant improvement for the naftidrofuryl group. These results confirm that naftidrofuryl is beneficial in the treatment of patients with chronic arterial disease.
Adult↗