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Biomedical subjects

J Azorin

Publications and source records attributed to J Azorin.

At least 19 recordsLinked to original sources
PubMed2005

The value of phase-contrast magnetic resonance angiography of the circle of Willis in predicting cerebral ischemia-hypoxia (shunt need) during carotid endarterectomy.

BACKGROUND: Cerebral perfusion during carotid cross-clamping depends on collateral function of the circle of Willis. The aim of this study was to determine the value of 3D Phase-Contrast (3D PC) MR angiography in predicting pre-operatively the need of shunting. METHODS: 3D PC MR angiography were performed in 121 patients before carotid endarterectomy under locoregional anaesthesia. Based on the MR analysis, the risk of cerebral ischemia-hypoxia during clamping was classified as high, moderate and low. The analysis was then correlated with intraoperative neurological examination. RESULTS: In patients with high risk of cerebral ischemia (n=9), immediate cerebral ischemia developed in all patients within one min of clamping (P<0.001). All nine underwent shunt placement. In six of the patients with moderate risk (n=46), cerebral ischemia occurred between 20 and 25 min after clamping; All occurred during intraoperative hypotension. CONCLUSION: 3D PC MR angiography can significantly determine the need of shunting in patients with important risk of immediate intraoperative cerebral ischemia. It also focuses on the intraoperative blood pressure stability in patients with moderate risk of ischemia.

Aged↗
PubMed2004

Chemokine receptor CXCR4 and early-stage non-small cell lung cancer: pattern of expression and correlation with outcome.

BACKGROUND: The expression of CXCR4 has been implicated in metastatic dissemination in different models of breast cancer and melanoma. In the present study, we evaluated CXCR4 expression in non-small-cell lung cancer (NSCLC) and the relationship between CXCR4 expression and the prognosis of stage I disease. PATIENTS AND METHODS: Using immunohistochemical analysis, we retrospectively analyzed CXCR4 expression in specimens from 61 patients with completely resected pathologically confirmed stage I NSCLC for whom clinical follow-up data were available. RESULTS: In the present study, we have shown that: CXCR4 is expressed by tumor cells in stage I NSCLC; CXCR4 is located in the nucleus and/or in the cytoplasm of tumor cells; strong nuclear staining was observed in 17 cases (29.8%); patients whose tumors had CXCR4-positive nuclear staining had a significantly longer duration of survival than patients whose tumors had no nuclear expression (P = 0.039, log-rank test). Interestingly, the 5-year metastasis rates were 23.5% and 34.1% in patients with CXCR4-positive and CXCR4-negative nuclear expression, respectively (P = 0.2). CONCLUSION: Strong CXCR4-positive nuclear staining was associated with a significantly better outcome in early-stage NSCLC. The mechanisms underlying this clinically and biologically important finding need to be further explored.

Adult↗
PubMed2001

[Tracheal replacement: new perspectives].

Tracheal replacement remains a real challenge in thoracic surgery. For tracheal resections greater than 5 to 6 cm, end to end anastomosis is not possible. Several solutions including prostheses, tracheal homografts and various autologous tissues have been proposed for tracheal replacement but all are associated with multiple complications and surgical difficulties. None of the numerous experimental studies have produced consistent results allowing for a standardized clinical approach. We propose the use of an autologous aortic graft for tracheal replacement. In a series of experiments, we have observed a progressive transformation of the arterial graft into a tracheal tissue after implantation. This observation raises interesting questions concerning histological adaptation and may offer new perspectives in human tracheal replacement.

Aorta↗
PubMed2000

Thoracoscopic excision of mediastinal bronchogenic cysts: results in 20 cases.

BACKGROUND: We present our experience with thoracoscopic resection of mediastinal bronchogenic cysts in adults. METHODS: From November 1990 to September 1993, 20 patients with mediastinal bronchogenic cysts were operated on by thoracoscopy. The average cyst size was 4.9 cm, and the largest diameter was 10 cm. Ten cysts were located in the middle mediastinum and 10 in the posterior mediastinum. Two cysts were complicated. RESULTS: Thirteen bronchogenic cysts were resected completely by thoracoscopy. We had to convert thoracoscopy into thoracotomy because of bleeding in two cases and because of major adhesions to vital structures in five cases. There were no operative deaths and no postoperative complications. Mean hospital stay was significantly less in the completely thoracoscopically treated group. Long-term follow-up (range, 4.5 to 7.5 years) showed no late complications and no recurrence. CONCLUSIONS: Preoperative complications, intraoperative injuries, and major adhesions to vital structures seem to be the only unfavorable conditions to thoracoscopic treatment of bronchogenic cysts. This study found encouraging results for thoracoscopic excision of mediastinal bronchogenic cysts in selected patients.

Adult↗
PubMed2000

[Metaplasia of aortic tissue into tracheal tissue. Surgical perspectives].

Tracheal reconstruction after extensive resection remains an unsolved surgical problem. Numerous attempts have been made using tracheal grafts or prosthetic conduits with disappointing results. In this study, we propose a new alternative using an aortic autograft as tracheal substitute. In a first series of experiments, a half circumference of two rings was replaced with an autologous carotid artery patch. In a second series, a complete segment of trachea was replaced with an autologous aortic graft supported by an endoluminal tracheal stent. No dehiscence or stenosis was observed. Microscopic examinations at 3 and 6 months showed the replacement of the aortic tissue by tracheal tissue comprising neoformation of cartilage and mucociliary or non-keratinizing metaplastic polystratified squamous epithelium. Although these results need to be confirmed by a larger series of experiments, they showed that a vascular tissue placed in a different environment with a different function can be submitted to a metaplastic transformation which tends to restore a normal structure adapted to its new function. These remarkable findings offer new perspectives in tracheal reconstruction in human.

Animals↗
PubMed2000

A new ESR dosimeter based on polytetrafluoroethylene

A new electron spin resonance (ESR) dosimetry system based on the ESR response of polytetrafluoroethylene is presented. The dose response of these dosimeters irradiated with 60Co gamma radiation was linear in the range from 6 x 10(2) up to 1.5 x 10(5) Gy, having a repeatability of +/-1% and a high degree of reliability (Cf = 1.054). The persistence of the signal was monitored over a period of one month. ESR signal decay was 5-7% in the temperature range from room temperature up to 40 degrees C.

Journal Article↗
PubMed2000

Experimental study on the in vivo behaviour of a new collagen glue in lung surgery.

OBJECTIVE: To study the pneumostatic ability of a collagen polymerised with a polysaccharide (GAO) glue in lung surgery; its influence in pleuro-pulmonary adhesion formation; the pulmonary tissue reaction to it, its biodegradability, and the eventual alterations of pulmonary compliance induced by the glue. METHODS: Two groups of ten rabbits (controls and treated) were operated under ventilatory assistance by thoracotomy to promote pleural adhesions, and injury to the lung. Repeated chest X-rays were carried out postoperatively. Lungs were examined histologically at day 40. In vitro tests were performed to study glue effects on pulmonary compliance. RESULTS: Air leaks stopped 2 min after glue application. Persistent pneumothorax were likely seen in treated rabbits (ns). Glue induces a temporary reduction of pulmonary compliance. Glue did not increase adhesion formation, or interfere with the healing process. CONCLUSIONS: For its properties, GAO seems to be a good and well-tolerated tool to reduce air leaks from the lung, without inducing residual pleural symphysis.

Animals↗
PubMed1999

Bilateral hemothorax revealing mediastinal parathyroid adenoma.

We report the case of a 63-year-old woman admitted to hospital because of bilateral hemothorax associated with acute respiratory failure and laterotracheal neoformation. A right thoracoscopy biopsy revealed a paratracheal parathyroid adenoma which was responsible for bilateral hemothorax and primary hyperparathyroidism. A curative resection was successfully performed by cervicotomy.

Adenoma↗
PubMed1999

Concomitant polymyositis and myasthenia gravis reveal malignant thymoma. A case report and review of the literature.

The frequency of thymona associated with autoimmune diseases has been reported to be increased, with 50% of thymoma patients also having myasthenia gravis (MG). Other autoimmune disorders, such as autoimmune erythroblastopenia and polymyositis (PM), have been less frequently associated with thymoma. The association of MG and PM with thymoma is rare. We here report the case of a 66-year-old woman whose concomitant MG and PM revealed malignant thymoma and review the other published cases of this association.

Aged↗
PubMed1998

Videothoracoscopic lung biopsy in diffuse infiltrative lung diseases: a 5-year surgical experience.

BACKGROUND: To establish an accurate diagnosis of diffuse infiltrative lung disease, a surgical lung biopsy may be required. We report our experience with video-thoracoscopic lung biopsy over a period of 5 years. METHODS: From March 1992 through December 1996, videothoracoscopic lung biopsy was performed in 64 patients (17 were women [26.5%]; age, 50.5+/-13 years) with a diagnosis of diffuse infiltrative lung disease of an unknown cause. All patients except one received general anesthesia. Single lung ventilation was used in 61 patients. All lung biopsies were obtained with an endoscopic stapler. RESULTS: Single lung biopsies were performed in 39 patients (61%), two biopsies in 23 patients (36%), and three biopsies in 2 patients. Minithoracotomies were necessary in 10 patients (15.6%) owing to an iatrogenic pulmonary wound (1 patient), extensive pleural adhesions (6 patients), and a stiff lung (3 patients). Postoperative complications were rare and included five discrete pneumothoraces (7.8%), all resolving spontaneously, one prolonged air leak (1.6%), and one hemothorax requiring reoperation. Three preoperatively debilitated patients died (4.7%), 2 with progression of respiratory failure and 1 owing to septic shock. Average chest tube duration was 2.4+/-2 days and average hospital stay was 4.6+/-2.5 days. Lung biopsy contributed to the diagnosis in 59 patients (92%). CONCLUSIONS: Videothoracoscopic lung biopsy using an endoscopic stapler is a safe and effective procedure in most cases and should be performed by trained thoracic surgeons.

Biopsy↗
PubMed1997

[Initial evaluation of thoracic injuries. Comparison of pulmonary radiography and x-ray computed tomography].

OBJECTIVES: To investigate the contribution of computed tomography scan (CTS) to the initial évaluation of chest trauma. PATIENTS AND METHODS: We carried out a two-year prospective study in all the chest trauma patients admitted to ICU. They underwent both Chest X-ray (CXR) and CTS within 24 jours of admission. CXR and CTS images were read by achieving a consensus between two radiologists who were unaware of the results of the other investigation. Then we compared these findings with the treatment received by the patients in the ICU. RESULTS: From July 1, 1991 through July 1, 1993, 56 patients were included (21 with conventional CTS and 35 with helicoidal CTS). CTS demonstrated a significant number of pleural (p < 0.001), parenchymatous (p < 0.001), and mediastinal (p < 0.01) lesions that escaped detection on CXR (CTS+/CXR- lesions). Thoracic drainage was done in 16 patients because of abnormalities CTS+/CXR- (p < 0.01); six patients with CTS+/CXR- pulmonary contusions received Pressure Positive Ventilation (p < 0.01); and four CTS+/CXR- lesions were treated surgically (p < 0.05). CONCLUSION: CTS adds significantly to the evaluation of chest trauma by allowing prompt, accurate assessment of lesions. In this study, over 50% of these lesions required specific treatment during the ICU stay.

Adolescent↗
PubMed1997

Role of videothoracoscopy in chest trauma.

BACKGROUND: The aim of this study was to evaluate videothoracoscopic procedures in the setting of chest trauma. METHODS: We retrospectively analyzed our experience of videothoracoscopy in patients with either blunt trauma or penetrating thoracic injuries. RESULTS: Forty-three procedures involving 42 patients were performed between July 1990 and April 1996. Indications for videothoracoscopy included suspected diaphragmatic injury (14 patients), clotted hemothorax (12), continued hemothorax (6), persistent pneumothorax (5), intrathoracic foreign body (4), posttraumatic chylothorax (1), and posttraumatic empyema (1 patient). Ten patients (24%) required conversion to thoracotomy. Two patients suffered postoperative pneumonia. There was one perioperative death. Mean hospital stay was 17 days; 21 days for patients with blunt trauma and 13 days for patients with penetrating injuries. There was no procedure-related complication. Videothoracoscopy allowed precocious discharge of patients suffering penetrating injuries and allowed faster recovery in the majority of patients suffering severe blunt trauma. CONCLUSIONS: Videothoracoscopy appears to be a safe, accurate, and useful approach in selected patients with chest trauma. It is ideal for the assessment of diaphragmatic injuries, for control of chest wall bleeding, for early removal of clotted hemothorax, for treatment of empyema, for treatment of chylothorax, for treatment of persistent pneumothorax, and for removal of intrathoracic foreign body. However, we do not recommend the use of this technique in the setting of suspected great vessel or cardiac injury.

Adolescent↗
PubMed1996

Complications of video-assisted thoracic surgery: a five-year experience.

BACKGROUND: Although thoracoscopy was originally described in 1910, recent developments in video-assisted surgical techniques and endoscopic equipment has expanded the application of video-assisted surgical procedures in the field of thoracic surgery. METHODS: In an effort to define both high-risk patients for video-assisted thoracic procedures and high-risk video-assisted thoracic surgical procedures, we reviewed the experience of four surgical institutions from June 1991 through May 1995. We looked specifically at complications resulting from the 937 video-assisted thoracic procedures performed during this period. RESULTS: Perioperative incidents or complications occurred in 35 patients (3.7%), and 116 procedures (12.4%) were converted to a thoracotomy. The in-hospital mortality rate was 0.5%, and death occurred principally in patients operated on for malignant pleural effusion. The overall incidence of postoperative complications was 10.9%, and the most prevalent complications were prolonged air leak (6.7%) and pleural effusion (0.7%). CONCLUSIONS: The incidence of complications was acceptable and, except for that of prolonged air leak, did not differ significantly from that resulting from analogous open procedures. Video-assisted thoracic surgery appears safe and particularly useful for some indications. However, the possibility of dramatic life-threatening perioperative complications requiring emergency conversion to thoracotomy justifies the fact that only trained thoracic surgeons should perform video-assisted thoracic surgical procedures.

Adolescent↗
PubMed1996

Embolization of multiple pulmonary arterial aneurysms in Behçet's disease.

Arterial manifestations of Behçet's disease carry a particularly poor prognosis, especially pulmonary arterial aneurysms. We report herein the successful embolization of multiple bilateral pulmonary arterial aneurysms in a young Algerian man, whose treatment included corticosteroids and immunosuppressive drugs.

Adult↗
PubMed1996

[Incidents and complications of therapeutic thoracoscopy. Apropos of 898 operated patients].

The exceptional interest in endoscopic surgery, both in laparoscopic surgery and video-assisted thoracoscopic surgery have led many teams to widen their indications. This movement has developed into a revolution in techniques demanded by patients, the public, and the medias, requiring many practicians to use these techniques more and more often and consequently to attempt very delicate operations. This "explosion" of endoscopic techniques has largely benefited from advances in equipment development (optics, video instrumentation) but has also required that operators acquire rigorous procedures for the proposed techniques. With the development of new thoracoscopic techniques for therapeutic indications, there are an unavoidable number of incidents and complications. These incidents and complications are related both to the use of instruments undoubtedly not well enough adapted to the procedures used and also to "forced" indications. We humbly recognize that a certain number of incidents are related to the necessarily inadequate experience of the operators during the "run in" period. We emphasize that video-assisted thoracoscopic surgery is a complementary technique among the available therapeutic armamentarium. We evaluated the mid and long term results of cancerology exeresis with these two techniques and underscore that morbidity and complications are rare but sometimes unacceptable. In conclusion, whatever the form of the technique used, it is an important evolution in surgery which must abide by the classical rules, in particular for indications in cancer surgery.

Endoscopy↗