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Biomedical subjects

G Escande

Publications and source records attributed to G Escande.

At least 19 recordsLinked to original sources
PubMed2001

Intrathoracic blood supply of the left vagus and recurrent laryngeal nerves.

The arteries and veins of the left vagus (VN) and left recurrent laryngeal (RLN) nerves from the thoracic inlet to the subaortic region are described following vascular casting with red colored latex in 6 adult fresh non-embalmed cadavers. In all specimens the anterior bronchoesophageal artery supplied at least one vessel to the VN and RLN in the subaortic region. For the RLN other arterial sources were arteries arising from the aortic arch in 1 specimen, the subclavian artery in 3 specimens, the first intercostal artery in 1 specimen, and the inferior thyroid artery in all specimens. For the VN other arterial sources were arteries arising from the aortic arch in 2 specimens and the inferior thyroid artery in 1 specimen. For both the VN and RLN the veins were located under the pleura and directed towards the internal thoracic vein anteriorly and the thoracic intercostal veins posteriorly. In conclusion, the inferior thyroid artery at the thoracic inlet for the RLN and the anterior bronchoesophageal artery are the more consistent vessels supplying the VN and RLN. Vascular damage occurring during mediastinal lymph node excision to the VN and RLN, especially in the subaortic region, may explain postoperative vocal fold paralysis.

Adult↗
PubMed2001

Vocal cord dysfunction after left lung resection for cancer.

OBJECTIVES: To evaluate the prevalence, the impact-related postoperative complications and the risk factors of vocal cord dysfunction (VCD) after left lung resection for cancer. METHODS: From February 1996 to April 1999, a review of prospectively gathered data was performed on 99 consecutive patients who underwent a pneumonectomy (n=50) or a lobectomy (n=49) with a mediastinal lymph node dissection. A fiber optic laryngeal examination was performed preoperatively for all patients and within the first week postoperatively in patients with symptom(s) or sign(s) of VCD or respiratory complications. RESULTS: Thirty-one patients (31%) had a postoperative VCD (group VCD) and 68 (68%) did not (group non-VCD). Mortality rate was 19% in group VCD and 9% in group non-VCD (P=0.13). Group VCD patients developed more pulmonary complications (P=0.014) and cardiac complications (P<0.001) compared to group non-VCD patients. A higher rate of reintubation (P=0.005), pneumonia (P=0.06), arrhythmia (P=0.002), cardiac failure (P<0.001) was noticeable in group VCD and may account for the higher rate of complications in this group. Using multivariate analysis, preoperative radiotherapy (P=0.001) and pneumonectomy (P=0.008) were predictive of postoperative VCD. Hospital stay was 22+/-16 days in group VCD and 13+/-9 days in group non-VCD (P<0.002). CONCLUSION: VCD is a frequent event that can lead to dramatic pulmonary complications. We would recommend to track it and to treat it as early as possible.

Aged↗
PubMed2001

Concomitant type I thyroplasty and thoracic operations for lung cancer: preventing respiratory complications associated with vagus or recurrent laryngeal nerve injury.

OBJECTIVES: We sought to prevent postoperative swallowing disorder, aspiration, and sputum retention in cases of recurrent laryngeal or vagus nerve section occurring during lung cancer resection. METHODS: In 14 of 25 consecutive patients, type I thyroplasty and thoracic operations were performed during the same period of anesthesia. All patients had a preoperative laryngeal computed tomographic scan providing us with indispensable measurements for vocal fold medialization under general anesthesia (ie, without intraoperative phonatory control). Nine remaining patients had a type I thyroplasty delayed from thoracic operations because of intraoperative doubt about laryngeal innervation injury, and 2 did not need a laryngeal operation. Main postoperative records consisted of swallowing ability, respiratory complications, and quality of voice. RESULTS: No swallowing disorder, aspiration, or sputum retention occurred in cases of concomitant laryngeal and thoracic operations. Of these 14 patients, a single case (7%) of major complication (vocal fold overmedialization) occurred and required an early and successful revision thyroplasty; one case of cervical hematoma that did not require surgical drainage was considered a minor complication (7%). Twelve (86%) patients who underwent the concomitant association of both operations were fully satisfied with their quality of voice. CONCLUSIONS: Type I thyroplasty and thoracic operation can be advantageously associated in case of injury to laryngeal motor innervation to prevent postoperative swallowing disability and dramatic respiratory complications.

Adenocarcinoma↗
PubMed1999

Prediction of hypoxemia and mechanical ventilation after lung resection for cancer.

BACKGROUND: Hypoxemia usually occurs after thoracotomy, and respiratory failure represents a major complication. METHODS: To define predictive factors of postoperative hypoxemia and mechanical ventilation (MV), we prospectively studied 48 patients who had undergone lung resection. Preoperative data included, age, lung volume, force expiratory volume in one second (FEV1), predictive postoperative FEV1 (FEV1ppo), blood gases, diffusing capacity, and number of resected subsegments. RESULTS: On postoperative day 1 or 2, hypoxemia was assessed by measurement of PaO2 and alveolar-arterial oxygen tension difference (A-aDO2) in 35 nonventilated patients breathing room air. The other patients (5 lobectomies, 9 pneumonectomies) required MV for pulmonary or nonpulmonary complications. Using simple and multiple regression analysis, the best predictors of postoperative hypoxemia were FEV1ppo (r = 0.74, p < 0.001) in lobectomy and tidal volume (r = 0.67, p < 0.01) in pneumonectomy. Using discriminant analysis, FEV1ppo in lobectomy and tidal volume in pneumonectomy were also considered as the best predictive factors of MV for pulmonary complications. CONCLUSIONS: These results suggest that the degree of chronic obstructive pulmonary disease in lobectomy and impairment of preoperative breathing pattern in pneumonectomy are the main factors of respiratory failure after lung resection.

Adult↗
PubMed1997

[A rare cause of accidental selective intubation: right upper lobar bronchus originating from the trachea].

A case of accidental selective intubation of a right upper lobar bronchus originating from the trachea, in a woman with a normal preoperative chest X-ray, is reported. The preoperative diagnosis of an asymptomatic tracheal bronchus is often difficult on a standard chest X-ray, especially since a chest X-ray is no longer systematically included in the preanaesthetic assessment. Therefore, the presence of a bronchial malformation should be considered as a cause of ventilatory problems, particularly those occurring after tracheal intubation.

Anesthesia, General↗
PubMed1996

[Preliminary analysis of the modifications of spinal curves, in extreme amplitudes, observed in rhythmic and athletic gymnastics].

Trained users of Rhythmic and Athletic Gymnastic, present kinetic spinal vast extents. Analysis, with pasted cutaneous markers, shows that, according to the codified movement, various segments of the vertebral column are requested and realized important displacements. Nevertheless, to have an homogeneous attitude, some subjects request more either lumbar or thoracic segments, of both. To prevent frequent spinal pain, it is important to realize a preliminary subject selection using their total spine and to improve protection by adapted gymnastic.

Adaptation, Physiological↗
PubMed1996

[Comparative study of static curves of the human spine in vivo during exercise and stretching in men and women].

Comparative study of static curves of the thoracic and lumbar spine in men and women has been realized under constraints of compression by weightlifting and elongation by exercise to parallel bars. In two athletic practices, curves decrease their arrow, ending to a straighter and more rigid column. This behavior expresses muscular actions. The greatest amplitude of displacement, observed in female series, shows lesser muscular forces in connection with a poor practice of exercises of body building.

Adaptation, Physiological↗
PubMed1994

Preliminary opto-electronic study on vertebral movement.

Opto-electronic systems utilising measurement of displacement of skin markers allows study of movement in the living subject. The authors have used this method in a kinematic study of the thoracic and lumbar spine measuring the displacement of skin markers placed over the spinous processes. It was possible to approach the physiological state of these complex movements once the apparatus had been calibrated to the correct level, and the error margins minimised. Repeated measurements confirmed the reliability of this method even if movement of the skin with respect to the bony reference points introduced some margin of error. Three dimensional displacement of the vertebrae were measured during voluntary movements of the spine demonstrating the complex geometry. Since opto-electronics are non-invasive they constitute an important advance in the study of the kinematics of the spine.

Adult↗
PubMed1994

[The capsulo-synovial folds of the intercondylar fossa of the human knee].

The study of the capsular insertions of the synovial membrane in the intercondylar fossa of the knee yielded information on the much debated anatomy of this area. In the cranial region, the insertions are found on the axial surface of each condyle, strengthening the dorsal attachment of the cruciate ligaments but remaining separate from these structures. In contrast, more caudalward, the cruciate ligaments, which are partly bordered by synovial lods recesses, are embedded in the posterior adipose mass and distinct from the bridging passage at a distance from the capsula.

Aged↗
PubMed1993

Malignant pleural tumor in a child mimicking a mesothelioma.

Malignant tumors of pleural origin are rare in childhood and difficult to diagnose. We report a case in a white 11 1/2-year-old girl who presented with a bulky tumour in the basal left lung field. There was an area of osteolysis at the ventral extremity of the 9th left rib allowing excision of the tumor by lateral thoracotomy. Macroscopically the operation was satisfactory. Despite two complementary excisions, chemotherapy with Vin-Caepi and consolidation chemotherapy followed by bone-marrow autograft, left pleural metastases appeared two years later. A second operation, a new course of chemotherapy with stage IV SIOP MMT, followed by a second bone-marrow graft and mediastinal radio-therapy, resulted in remission. At the time of this report, after three and a half years of evolution, the child's condition is satisfactory and she leads a normal life without treatment. A probable diagnosis of pleural mesothelioma was arrived at by elimination. This kind of tumour, without specific markers, is difficult to distinguish from small-round-cell tumors. Evolution is unpredictable and often rapidly fatal. Although these tumors generally have a weak response to chemo- and radiotherapy, we think that close follow-up and active therapy, rapidly initiated at the slightest sign, can improve the quality of life of the patients and increase their survival.

Child↗
PubMed1992

Contribution of imaging to the understanding of the female pelvic fasciae.

According to the ultrasound and MRI findings, supported by planned dissections, the female perineum is organised around the musculofascial system converging towards the fibrous structure of the central perineal tendon (CPT). Behind the CPT the fascial layers form part of a fibrous assembly extending from the ventral surface of the sacrum to the anal complex, prolonging the direction of the sacral concavity downwards and forwards. On the other hand, in front of the CPT the fasciae fuse to form two aponeurotic bands circumscribing the urogenital fossa. The fascial system is reinforced cranially by the structures of the hypogastric sheath and the uterosacral ligaments. The weak point of the urogenital fossa is partly filled by the urethral-clitoridal-vulvar complex. The perineum so formed plays a cardinal role in stabilising the pelvic viscera. Stress is placed on the firmness of the posterior perineum, a key element in pelvic stability. The posterior perineum is often involved in pathological conditions and a good acquaintance with these structures is essential in defining therapeutic indications.

Adult↗
PubMed1992

[Correlations of CT and MRI imaging of the lateral pterygoid muscle].

On the basis of 15 CT scan and MRI studies of normal volunteers, the authors describe the features the lateral pterygoid muscle. A good correlation appears between CT and MR images which would be useful in the staging of tumors in this space, and in the pathophysiology of internal derangements of the temporomandibular joint (TMJ).

Humans↗
PubMed1992

[Mediastinal hemangiopericytoma. Apropos of a case].

The authors report a new case of hemangiopericytoma in an elderly man. An asymptomatic mediastinal mass was found on a routine chest film. C.T. guided fine-needle biopsy was diagnostic. These rare lesions are clinically and radiologically aspecific and require pathologic proof. The value of percutaneous biopsy before therapeutic decision is emphasized.

Aged↗