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Biomedical subjects

C Boutin

Publications and source records attributed to C Boutin.

At least 19 recordsLinked to original sources
PubMed1992

Balloon atrial septostomy under transesophageal echocardiographic guidance.

Balloon atrial septostomy is an established method of palliation for several forms of congenital heart disease. Previously performed under fluoroscopic x-ray control, recent reports have demonstrated the utility of transthoracic echocardiographic monitoring. We report the first application of uniplane transesophageal echocardiography (TEE) (6.7-mm probe) as an alternative imaging modality for control of balloon atrial septostomy on neonates in the intensive care unit.

Catheterization↗
PubMed1992

[An experimental anatomopathological study of pleural talcosis].

The aim of this work was to study the anatomical and pathological reaction and the mechanism of the formation of the pleural symphysis during pleural talcosis. The experiment was performed on fifteen dogs of similar breed, divided into three groups of five subjects each. After thoracoscopy under general anaesthesia, 2 ml of intrapleural physiological saline were injected in group I (controls) and 2 or 4 ml of talc granules in group II and III. A drainage tube was positioned at the end of the examination. One dog in each group was sacrificed on the 1st, 2nd, 7th, 15th, and 30th days post-thoracoscopy. At autopsy a detailed macroscopic study was carried out and some biopsies were taken for histology. In the control group, the inflammatory reaction was very moderate and rapidly disappeared whereas in the groups treated with talc, the talc led to an exudate of several millimeters, the exudate of inflammatory reaction was acute and early (J1) and involved the pleural in particular on the costal surface and was more moderate on the visceral surface and only involved the lung to a thickness of 2 or 3 mm and a few peripheral alveolar spaces. The granulomatous reaction occurred later (from the 3rd day) and was accompanied by the formation of a symphysis by the deposition and coagulation of fibrin which continued from the 7th to the 15th day, and became solid on the 30th day post-thoracoscopy. There was no significant difference between the two groups treated with talc, implying that the reaction was linked to the talc and was independent of the dose used.

Animals↗
PubMed1992

[Pleural amyloidosis: thoracoscopic diagnosis and physiopathological approach].

The authors report a case of pleural amyloidosis presenting as a generalised primary amyloidosis with immunological disturbance, in which the diagnosis was made at thoracoscopy. Bronchopulmonary disease during the course of generalised amyloidosis is frequent, but there are only thirteen cases of histologically proven pleural amyloidosis which have been reported in the literature. Using pleuroscopy the histology obtained enables a pathophysiological approach to this disease, taking account of the cells and enzymes found in the pleura, the inflammatory reactions suggests a local production at the pleura level and this would explain the exudative character of some effusions, although a transudate is most often described and is directly linked to congestive cardiac failure. The deposit of fibrin by occluding the stomas of Wang, explains the failure of the absorptive properties of the pleura and also the recurrent nature of these effusions. The pleural disease is without doubt, under-estimated in generalised amyloidosis and the character of the effusions variable. Most often there are transudates secondary to congestive cardiac failure, although exudates occur as a result of local inflammatory phenomena. Amyloidosis should be remembered as a possible cause of exudative pleurisy.

Aged↗
PubMed1992

[Sequential administration of a reduced dose of almitrine to patients with chronic obstructive bronchopneumopathies. A controlled multicenter study].

Recent multi-centre studies have shown that high doses of Almitrine (100-200 mg per day), lead to a significant improvement in the hypoxaemia of patients presenting with chronic airflow obstruction, but that a high blood level (greater than 500 ng/ml) is often seen after 1 year, sometimes associated with signs of peripheral neuropathy. In order to maintain Almitrine blood levels in the range 200-300 ng/ml we have used an intermittent regime (with a "window" of 1 month every 3 months) and a dose limited to 100 mg per day. 102 hypoxic patients with chronic airflow obstruction, who were in a stable state were included. 65 patients were in the Almitrine group (A) and 37 patients in the placebo group (P). The treatment lasted for 1 year. In addition there was a 3 monthly follow up with arterial blood gases and spirometry, a clinical neurological examination and also electrophysiology, initially and after 6 and 12 months. 43% of patients in group A and 32% of patients in group P, left the study, most often due to poor cooperation, but sometimes as a result of side effects. After 12 months the PaO2 rose significantly in group A from 59.1 +/- 0.7 to 65.8 +/- 1.6 mmHg (p less than 0.001) whilst it was not changed in group P. The PaCO2 did not change in either group. On the other hand there was a significant fall in the subgroup of patients with hypercapnia in group A (p less than 0.001). The outcome of the neurological and electrophysiological assessments did not show any significant difference between the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

[Diseases of the pleura. Materials used and study technics].

Pleural diseases frequently pose problems to the pulmonary physician. The clinical and radiological approaches are often insufficient and it is necessary to resort to techniques which enable a precise morphological diagnosis of the pleural lesion. Starting with a needle puncture and biopsy, the medical investigation of the pleura has been enriched by thoracoscopy which enables visualisation of not only the parietal and visceral pleura and the lung but also the mediastinum and the pericardium. Using this technique the diagnostic yield and the harmless nature of the technique are of the first importance. After recording traditional techniques of investigation of lung disease (puncture, needle biopsy) the equipment, the technique, the indications and the risks and the diagnostic results from thoracoscopy are discussed.

Biopsy, Needle↗
PubMed1992

[Malignant mesothelioma: prognostic factors in a series of 125 patients studied from 1973 to 1987].

A continuous series of 125 patients hospitalized between 1973 and 1987 with pleural malignant mesothelioma were the subjects of this stepwise analysis. A diagnostic thoracoscopy was carried out in every patient and the histopathological diagnosis confirmed by the French Mesothelioma Panel of Pathologists. The main characteristics of the patients were: mean age 64 +/- 1 year, 104 male, 21 female; previous asbestos exposure was present in 98. The histopathological type was epithelial in 90, mixed in 22, fibrosarcomatous in 13. The endoscopic aspect was analysed in the same manner from the beginning as follows: involvement of the parietal, diaphragmatic or visceral pleura; extension of the tumor into the pleural cavity, macroscopic aspects of the lesions. According to the Butchart's classification 56 patients were at stage I, 61 at stage II, 3 at stage III, 5 at stage IV. A multivariate analysis (Cox model) showed that the best prognostic factor is the stage I which can be divided in 2 subtypes: exclusive involvement of the parietal and diaphragmatic pleura without invasion of the visceral pleura: stage IA (median survival 31.2 months). It is 6.75 months as soon as the visceral pleura is invaded (stade IB).

Aged↗
PubMed1992

Extended thoracoscopy: a biopsy method to be used in case of pleural adhesions.

Extended thoracoscopy (ET) allows several large biopsies to be taken in patients with thick adhesions of the pleura when normal thoracoscopy is impossible. Twenty patients with undiagnosed pleural effusion or thickening and two with associated pulmonary tumour close to the chest wall underwent ET because closed adhesions prevented the induction of an artificial pneumothorax. Under local anaesthesia and neuroleptanalgesia, at the site of suspected lesions on computed tomographic (CT) scan, a cutaneous incision of 3-4 cm is made on the appropriate intercostal space. After dissection with blunt scissors, the operator introduces his finger to create a space in the pleural cavity. The thoracoscope is inserted to inspect the pleura and to take several biopsies for histopathological examination. A chest tube is inserted for a few minutes after checking airtightness and haemostasis. The procedure is well-tolerated. In three cases no pleural biopsy could be taken; in three patients a false negative diagnosis was observed. A correct diagnosis was obtained in 16 out of 19 patients (84%). If performed by a pulmonologist experienced with thoracoscopy ET is a rapid, safe and efficient method to obtain biopsies in cases where normal thoracoscopy after induction of a pneumothorax is not possible. It considerably reduces the need for open thoracotomy.

Adolescent↗
PubMed1991

Thoracoscopic talc poudrage pleurodesis for chronic recurrent pleural effusions.

OBJECTIVE: To assess the effectiveness of thoracoscopic talc poudrage for the treatment of chronic pleural effusions. DESIGN: Prospective evaluation. SETTING: Kaiser-Permanente Hospital. PATIENTS: Forty-seven consecutive patients with recalcitrant pleural effusions, referred for thoracoscopy. INTERVENTION: Patients received general or local anesthesia; 42 had a 7-mm rigid thoracoscopic examination followed by insufflation of 5 mL of talc. Patients then had chest-tube drainage. MEASUREMENTS: We recorded clinical characteristics, final diagnosis, procedure-related pain and morbidity, days of hospitalization, patient-reported degree of symptom relief, and chest roentgenographic results at 1, 3, and 12 months. All patients were followed for 16 months or until death. MAIN RESULTS: Of 39 evaluable patients, all reported prolonged relief of effusion-related dyspnea. Radiographic results confirmed the elimination of pleural effusions in 34 patients (87%), including all 11 with benign conditions and 23 of 28 (82%) with malignancies. Treatment failed in three patients because of entrapped lung and in two patients with mesotheliomas whose effusions recurred more than a year after treatment. No procedure-related mortality or morbidity was found. Ambulatory patients required hospitalization for a mean of 3.9 days (range, 2 to 11 days). Mild pain was reported by some patients. The mean duration of chest-tube drainage was 2.7 days (range, 1 to 9 days). Patients with malignant disease lived an average of 12.4 months (range, 1 to 61 months) after the procedure. CONCLUSIONS: Thoracoscopic talc poudrage is an effective pleural sclerosing technique and is relatively painless.

Adult↗
PubMed1991

Activity of intrapleural recombinant gamma-interferon in malignant mesothelioma.

Twenty-two consecutive patients with malignant diffuse pleural mesothelioma were treated with recombinant gamma-interferon by the intrapleural route. Diagnosis was made by thoracoscopic examination and all cases were confirmed by the French Mesothelioma Panel of Pathologist. Patients were staged based on thoracoscopic examination and computed tomography (CT) scan: 12 patients were classified as Stage I and 10 were Stage II. A solution of gamma-interferon (40 X 106 U) was infused twice a week over 2 months. Every patient experienced fever. One patient had a Grade 2 leukopenia and one patient suffered from pleural empyema. Response evaluation was based on the following: (1) CT scan performed 2 weeks after treatment ended, and (2) repeat thoracoscopic examination with histopathologic verification in nine patients who had demonstrated a stabilization or a regression of the disease on CT scan. From the original group, 19 patients could be evaluated. Four complete thoracoscopic histopathologic responses and one partial response were observed in Stage I patients (56%). One partial response was observed in Stage II patients.

Alkaline Phosphatase↗
PubMed1991

[Is chemotherapy with cisplatin useful in non small cell bronchial cancer at staging IV? Results of a randomized study].

The benefit of chemotherapy for patients with disseminated non small cell lung cancer (NSCLC) is controversial. The introduction of cisplatinum in the combination chemotherapy for NSCLC gave rise to higher response rates. To study the question of the usefulness of cisplatinum-based chemotherapy in disseminated NSCLC we conducted a prospective randomized trial comparing best supportive care to vindesine + cisplatin. Between December 1985 and March 1988, 49 patients with stage IV NSCLC were enrolled. Of the 46 eligible patients 24 were in the chemotherapy group and 22 in the best supportive care group. The treatment groups were not significantly different in terms of age, performance status, histology. Toxicity on the chemotherapy arm grade 3 or more was observed in 17.5% for neutropenia, in 8.75% for vomiting. There was one death related to treatment. The overall response rate in the chemotherapy group was 41.7%. Patients of the chemotherapy group had a median survival time of 199 days and the patients of the best supportive care group had a median survival time of 73 days. The difference in survival is highly significant (p less than 0.001).

Adult↗
PubMed1991

[Lipid pneumopathy and bronchopulmonary adenocarcinoma. Apropos of a case].

The authors report a case of a patient aged 83 who presented with a lipid pneumonia and a primary broncho-pulmonary adenocarcinoma of the left lower lobe. The diagnosis of the lipid pneumonia was confirmed following broncho-alveolar lavage and the autopsy confirms the neoplastic origin of the mass lesion at the left base. The authors report 16 similar cases in the literature between 1943 and 1989.

Adenocarcinoma↗
PubMed1990

[Diagnosis of pleurisy].

Nowadays, the diagnosis of pleural effusion is greatly facilitated by thoracoscopy. Since most pleural effusions are due to neoplasias (notably in patients older than 40 years) and since the prognostic value of an early diagnosis is obvious in case of pleural carcinoma (notably mesothelioma), there is no justification in allowing the effusion to become chronic. If the diagnosis is confirmed by needle biopsy, thoracoscopy can rapidly be performed by skilled operators: in 95 p. 100 of the cases it provides the diagnosis. Five per cent of pleural effusions remain of unknown origin. In such cases the patients must be closely followed up for 12 to 18 months to make sure that no cancer has been missed and another thoracoscopy must be performed at the slightest clinical change. Test treatments (antibuberculous drugs, corticosteroids) are now obsolete.

Biopsy, Needle↗
PubMed1990

[Epidemiology and etiology of mesothelioma].

The early diagnosis of mesothelioma rests on very common clinical evidence, including pleuritis of recent onset, history of contact with asbestos chest pain, often moderate loss of weight and slight changes in old pleural images. The sensitivity of formal diagnostic examinations is 23 p. 100 for pleural fluid cytology, 24 p. 100 Adams' needle biopsy and 93 p. 100 for thoracoscopy, where the only negative results are obtained in patients with adhesive pleuritis. Prognosis depends on several factors, the most favourable ones being the histological type of the lesion (epithelial or mixed), the fact that it is limited to the parietal or diaphragmatic pleura and, on the patient's side and accessorily: female sex, lack of exposure to asbestos, age under 50, good general condition and absence of chest pain.

Asbestos↗
PubMed1990

[Diagnosis and prognosis of malignant mesothelioma].

The early diagnosis of mesothelioma rests on very common clinical evidence, including pleuritis of recent onset, history of contact with asbestos, chest pain, often moderate loss of weight and slight changes in old pleural fluid cytology, 24% for Adams' needle biopsy and 93% for thoracoscopy, where the only negative results are obtained in patients with adhesive pleuritis. Prognosis depends on several factors, the most favourable ones being the histological type of the lesion (epithelial or mixed), the fact that it is limited to the parietal or diaphragmatic pleural and, on the patient's side and accessorily: female sex, lack of exposure to asbestos, age under 50, good general condition and absence of chest pain.

Adult↗
PubMed1990

The role of thoracoscopy in the evaluation and management of pleural effusions.

Diagnostic thoracoscopy is indicated in every patient where the usual investigations (including biochemistry, cytology, bacteriology, occasionally needle biopsy of the pleura) do not achieve a precise diagnosis. The percentage of so-called "idiopathic" effusions, amounting to approximately 20% in many published series, can be reduced to 4% after thoracoscopy. The sensibility of thoracoscopic biopsy reaches 93-97% of malignant or tuberculous pleural effusions. The procedure requires a short hospitalization of about 36 hr, and complications are rare. Therapeutic thoracoscopy is frequently performed in chronic, malignant, recurrent effusions in order to achieve a pleurodesis by means of a talc poudrage under visual control. The efficacy of the poudrage in the published randomized studies is better than tetracycline. About 90% of patients are cured, the effusion being totally suppressed. Side effects are rare if the quantity of talc does not exceed 10 ml.

Diagnosis, Differential↗