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Biomedical subjects

G Morand

Publications and source records attributed to G Morand.

At least 19 recordsLinked to original sources
PubMed1992

Pleuropulmonary aspergilloma: clinical spectrum and results of surgical treatment.

From 1974 to 1991, 77 patients were admitted for pulmonary (55), pleural (16), or bronchial (6) aspergilloma. About 50% were asymptomatic. Sixty-three underwent operation. Pulmonary aspergillomas were operated on for therapeutic need in 26 and on principle in 18; the procedures were 28 lobar or segmental resections, 10 thoracoplasties, and 5 pleuropneumonectomies (1 patient had exploration only). Pleural aspergillosis was treated by operation on principle in 5 and for therapeutic need in 8 patients; 10 thoracoplasties, 1 attempt at pleuropneumonectomy, and 2 decortications were performed. All six bronchial lesions were operated on as a rule. Overall postoperative mortality was 9.5%. Major complications were bleeding (n = 37), pleural space problems (n = 24), respiratory failure (n = 6), and postpneumonectomy empyema (n = 4). All patients with pleural disease experienced complications. The outcome was better after lobar or segmental resection than after thoracoplasty (mortality, 6% versus 15%). Asymptomatic and nonsequellary pulmonary or bronchial aspergilloma also had an improved outcome. We conclude that operation is at low risk in pulmonary or bronchial locations in asymptomatic patients and in the absence of sequellae; the risk is high in symptomatic patients for whom operation is the only definite treatment. Pleuropneumonectomy should be avoided. Only symptomatic pleural aspergilloma should be operated on.

Adolescent↗
PubMed1992

[Lobectomy extended to the main bronchus in the treatment of bronchial cancer (seventy-three cases)].

Sleeve allow excision of bronchial carcinoma in patients not able to functionally tolerate pneumonectomy. Our series consists of 73 patients operated over the last thirty years. Implantation of the bronchus was treated either by wedge resection or by complete resection followed by reimplantation. This procedure was performed for respiratory functional reasons in 39 cases (53%), on principle in 27 cases (37%) and in palliative indications in 7 cases (10%). The high perioperative mortality (6.8%) and morbidity (20%) were related to bronchovascular complications which were eliminated over the last decade. Local recurrences (23%) were more frequent than following conventional resections. On the other hand, the survival, 80% at one year, 62% at 2 years, 54% at 3 years and 39% at 5 years, related more to metastatic dissemination than to local recurrence, was comparable to that of the control group of pneumonectomised patients. This procedure gave identical results in terms of survival, but should be reserved for patients with respiratory failure due to the increased risk of local recurrence.

Adult↗
PubMed1992

[Forgotten mediastinal goiter: seven cases].

The authors relate their experience with 7 cases of mediastinal goiter residual to a subtotal thyroidectomy for substernal goiter. The differential diagnosis with ordinary recurrence was based on the absence of connection with the cervical remnant. The reasons for surgical decision-making was mediastinal compression in 4 patients, hyperthyroidism in 1 patient and absent diagnosis in 1 patient; surgery was systematic in 1 asymptomatic patient. Sternal splitting incision was required in 6 patients: alone in 3, associated with cervical incision in 3 others; excision by an exclusively cervical route was possible in one patient. No malignancy was discovered. Postoperative outcome was uncomplicated in all patients. The residual goiter has the same clinical and paraclinical presentation as the ordinary intrathoracic goiter; treatment should be principally surgical for the same reasons. Nevertheless, for this mediastinal tumor, sternum-splitting incision will be required in most cases.

Aged↗
PubMed1992

[Diaphragmatic hernia complicating omentoplasty after thoracic wall excision. Reflections apropos of 2 cases].

The authors relate two case-reports of diaphragmatic hernia occurring after antero-lateral chest-wall resection and repair with an omental flap. Both patients had undergone a prior lung resection for bronchogenic cancer, and the indication for chest-wall resection was parietal neoplastic recurrence. In both patients, the omental flap was brought up to the chest wall defect by a direct transdiaphragmatic route; prosthetic material was note used. The hernia presented once as early post-operative evisceration, and once as proximal obstruction due to gastric herniation. The causes of these two complications are analysed. Omentoplasty was justified twice, since the latissimus dorsi had been severed during the prior thoracotomy. Prosthetic material might have been useful to one of the patients, but not to the second who had undergone pneumonectomy. The transdiaphragmatic passage of the omentoplasty was certainly responsible for the herniae and should be avoided.

Aged↗
PubMed1992

[Complications and mortality of surgery for bronchogenic cancers].

Resection surgery for lung cancer is beset with specific or non-specific complications which often darken the prognosis for life. The specific complications, related to surgical dissections, are mainly per- and postoperative haemorrhages of various origins and, less frequently, disturbances in respiration, nerve wound or chylothorax. Soon after pneumonectomy a bronchial fistula encouraged by different factors may appear (3.3% of the cases) and empyema, usually caused by staphylococci, may develop (3%). Non-specific complications may disturb the post-resection period, involving the lungs (atelectasia, parenchymal infections, acute respiratory failure) or the cardiovascular system (pulmonary embolism, dysarrhythmia). The overall perioperative mortality rate has decreased with time owing to advances in anaesthesia and intensive care: in the hands of certain medico-surgical teams it does not exceed 3%. It is significantly lower in lobar (mean: 4.5%) than in pulmonary (mean: 8.4%) resections. Enlarged resections and lymph node dissections are aggravating factors. Patients aged 70 or more do not tolerate these operations so well: their mean overall mortality rate is twice that observed in younger patients (8% on average and up to 20%). Resection surgery for lung cancer remains a necessarily hazardous procedure but is the only treatment that can cure the patient. Its success is directly conditioned by a good preoperative risk evaluation.

Age Factors↗
PubMed1991

Emergency repair of main stem bronchus disruption complicated by anastomotic stenosis: two cases of successful repair by resection and reanastomosis.

The case reports of two patients who developed complete bronchial stenosis after emergency repair of a left stem bronchus disruption are reported. Resection of the stenotic bronchus and reanastomosis restored a normal lung function in both patients. Arguments for a conservative approach, perioperative investigations, and technical data are discussed.

Accidents, Traffic↗
PubMed1991

[Non-aplastic N2 operated bronchial cancers. Multifactorial analysis of the prognosis].

The marked disparity of the published 5-year survival rates (0 to 3%) for non-anaplastic, operated N2 lung cancers would suggest the marked heterogeneity of the patients studied. We prospectively studies 97 N2 tumours for which "curative" resection was performed between 1983 and 1986. The overall survival rate was 28% at 3 years, 19% at 4 years and 12% at 5 years. Survival was studied on the basis of several parameters concerning the tumour: histological type and degree of differentiation, T (TNM), modality of invasion (circumscribed, infiltrating), the quality of the stroma (absent, fibrotic, cellular), the mitotic index, the necrosis rate, presence or absence of microscopic invasion of blood vessels; and concerning the nodes: site, number (solitary, multiple), size of the metastasis (massive, microscopic), macroscopic or microscopic invasion of the capsule. We know the outcome for all of our patients: 81 have died and 16 are still alive. Sixty-one have developed metastases, 5 have developed local and regional recurrences and 3 have both a recurrence and metastases. Univariate analysis demonstrated that a small number of parameters significantly influence survival: microscopic invasion of blood vessel (chi 2 = 5.24, p less than 0.02), macroscopic and microscopic invasion of the lymph node capsule. In order to more clearly define the prognostic factors, we used Cox's multidimensional model. This model was applied to the three significant parameters to which we added two other variables which non-significantly tended to be related to survival: tumour necrosis and number of lymph nodes involved.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1991

[The risks of surgical training. A study apropos of 348 pneumonectomies].

On the basis of the retrospective study of a series of 348 pneumonectomies, the authors have attempted to assess whether the risks of postoperative complications were increased if the operation was carried out by trainee surgeons. All operations were performed for cancer, with a stapler being used for bronchial suture. The patients were classified in three groups according to the surgeon: 133 (38%) were operated by an University professor (group I, 2 surgeons), 171 (49%) by chief resident or hospital practitioner (group II, 3 surgeons) and 44 (13%) by an intern (group III, 14 surgeons). The homogeneity of the 3 groups was checked with alpha X2 test. The study dealt with the overall mortality as well as with the specific complications of pneumonia, namely empyema and bronchopleural fistulae. The overall postoperative mortality rate was similar in the 3 groups (respectively 8%, 8% and 5%), as well as the occurrence of empyema (respectively 4%, 3% and 5%). A difference that, though not significant statistically, is not negligible, appears for bronchopleural fistulae, which complicate 9% of the operations carried out by interns vs. 4% in the other 2 categories. These observations challenge a number of studies claiming that surgery performed by inexperienced surgeons is innocuous. However, pneumonectomy is an essential step in the training to thoracic surgery, so that no candidate with sufficient surgical maturity should be prevented from performing it.

Female↗
PubMed1990

[Exploratory thoracotomy of necessity in surgery of bronchial cancer].

The survey conducted by the French Language Society of Thoracic and Cardiovascular Surgery collected a total of 2,962 exploratory thoracotomies for lung cancer performed over a period of 10 years. Over the same period, 25,291 operations were performed for lung resection, so that the mean rate of exploratory thoracotomy was therefore 11.7%. The rate of exploratory thoracotomy varied from one unit to another (2.7% to 45.8%) and appeared to be virtually independent of the operative activity. It has continued to decrease over time, which is even more significant in view of the fact that the operative activity has increased in all of the units. The local and regional spread of the tumour represents the principal reason for non-resection (79% of cases); it was less common in units with a high operative activity (72%) than in other units (84%) especially when the mediastinal lymph nodes were involved. The major thoracic surgery units also appear to be distinguished by a greater audacity, as well as an increased failure rate in the case of tumour spread to the trachea. The risk of exploratory thoracotomy is considerable as it was responsible for death in 3% of cases. A better radiological and clinical assessment, rather than the use of mediastinoscopy should avoid 2% of these useless explorations. The subsequent course of these patients barely concerns the surgeon: it is rapidly unfavourable and the rare long-term survivals (2% at five years) are not sufficient to justify operation at any cost.

Bronchial Neoplasms↗
PubMed1990

[Postoperative intensive care after thymectomy for myasthenia gravis].

The post-operative management of the myasthenic patient after thymectomy through sternotomy has changed in the last decades. After years of routine preoperative tracheostomies followed by routine prolonged intubation nowadays it is possible to wean the patients from the ventilation and to extubate them early after surgery while reintroducing the acetylcholinesterase inhibitors therapy. A series of 15 patients operated on between 1985 and 1988 for removal of thymic rests or thymoma is presented and confirms this evolution. The clinical and gazometric criteria allowing an early weaning from the ventilator are analyzed. However certain patients with the most severe forms of myasthenic still need prolonged ventilatory support.

Adult↗
PubMed1990

[Development of 62 typical carcinoid tumor of the bronchi surgically treated. Prognostic value of histopathological features].

The pathological and clinical features of 62 carcinoid tumours of the bronchus operated between 1975 and 1987 were reviewed in order to determine the prognostic value of certain parameters: limit of proliferation, vascular invasion, lymph node involvement. This series corresponded to 36 central tumours and 25 peripheral tumours, all treated surgically. One patient was lost to follow-up, 3 developed recurrences, 56 are still alive without recurrence and 3 died from intercurrent causes. The histological appearance of the tumours was homogeneous and typical. Twenty-eight lesions were strictly intrabronchial, 34 invaded the lung with incomplete limits in twenty cases. The tumour showed signs of vascular invasion in ten cases and the adjacent lymph nodes were invaded in eight cases. The local recurrence was undoubtedly related to an excessively conservative primary resection, as the primary tumour did not demonstrate any unusual features. The two tumours which metastasized showed vascular invasion: one metastasized to a hilar node, but these features were observed in other cases which retained a benign course. The standard histological diagnosis of typical carcinoid tumour does not appear to raise any particular difficulties; it is reliable. The course of the disease is sometimes malignant but no histological parameter is able to accurately predict this outcome.

Adult↗
PubMed1990

[Perfusion scintigraphy and surgical excision of bronchial cancers].

In a series of 1,800 operated lung cancers, 93 had a unilateral perfusion scan less than or equal to 20% (36 perfusions = 0, 15 between one and 10% and 42 between 11 and 20%). Major amputations were more frequent on the left side and constituted a pejorative but non-decisive factor for surgical nonintervention although was not synonymous with inoperability. The extent of the resection increased with the severity of the amputation.

Carcinoma, Bronchogenic↗
PubMed1990

[Outcome of 100 necessary exploratory thoracotomies for bronchial cancer].

The outcome of one hundred exploratory thoracotomies for lung cancer (9.1% of operations) was studied. There were 4 postoperative deaths. After the operation, 6 patients did not receive any further treatment, 62 received radiotherapy, 25 received a combination of radiotherapy and chemotherapy and 3 received chemotherapy. The disease-free interval was very short with development of metastases (55 cases) and local recurrences (29 cases). The survival was also short: less than 10% at 2 years; it was significantly poorer than that observed in a group of non-operated patients with an equivalent stage of lung cancer. These findings suggest the need for stricter evaluation of operative indications.

Aged↗
PubMed1989

Immunotherapy as an adjuvant to surgery in carcinoma of bronchus. Results in three randomised trials.

The results of non-specific immunotherapy adjuvant to surgery in the treatment of non-small cell lung cancer were studied in three separate randomised clinical trials involving 344 patients. The first study involved 126 patients. In 73, intrapleural BCG was given according to McKneally's technique. They were compared to a control group of 63 patients. In the second trial, levamisole was administered to 43 patients who, in addition to surgery, also had radiotherapy. These were compared with 43 control patients. In the third study, 60 patients underwent surgical operation for limited lesions and in addition received Isoprinosine. These were compared with a control group of 60 patients. All patients in the control groups of the three studies had similar surgical operations to their treated counterpart. The overall results showed no difference between those who received immunotherapy and the control groups of patients and that the use of these agents did not alter either the course of the disease or the incidence of its recurrence.

Adenocarcinoma↗
PubMed1989

[Bronchiolo-alveolar carcinoma. Anatomo-pathological and evolutional study of a series of 52 operated cases].

The postoperative outcome of bronchiolo-alveolar epithelioma (EBA) is unpredictable. We question whether a study of the anatomo-pathological structures would enable us to detect prognostic indicators. The clinical characteristics, histopathology and outcome of 52 cases of EBA were studied. 31 tumours were detected in a systematic fashion; 50 patients had excision of the tumour and in 39 cases there was no invasion of the lymphatics. 10 were of the multicentric variety and 42 were of the nodular variety and 9 of these were the centre of an inflammatory lympho-plasmocytic reaction. 20 cases revealed mucinous differentiation and 32 were non-mucinous. In the latter cases nucleo-cytoplasmic anomalies were only slightly increased or even absent. Blood vessel invasion was present in 12 cases and metastases to the air spaces in 20. The overall survival was 83% in the first year, 65% in the second year, 42% at five years and 26.5% at 10 years. The nodular lesions were compatible with a significantly better survival than the diffuse forms. Other characteristics such as whether the tumour was mucinous or not, inflammatory, showed nuclear anomalies, blood vessel invasion and airborne metastases did not seem to affect survival.

Adenocarcinoma, Bronchiolo-Alveolar↗