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Biomedical subjects

J Deslauriers

Publications and source records attributed to J Deslauriers.

At least 19 recordsLinked to original sources
PubMed1997

Surgery for small cell lung cancer.

Operative management of small cell lung cancer generally yields little benefit because these tumors are known for their propensity to disseminate early to regional lymph nodes and distant sites. Primary surgery followed by chemotherapy is however indicated in very early stage tumors where survival approximates that of resected non small cell lung tumors. Surgery as an adjuvant to combination chemotherapy is also advocated by some authors to downstage the tumor and render it resectable. Candidates for salvage procedures include patients who have achieved complete response with chemotherapy, but subsequently relapsed within the chest at the site of the primary tumor.

Carcinoma, Small Cell↗
PubMed1996

Technique for the repair of diaphragmatic eventration.

In contrast to the large thoracotomy incisions required by standard surgical techniques for repair of diaphragmatic eventration, the procedure we developed can be performed by video-assisted thoracoscopy, thus offering patients the advantages of a minimally invasive operation. Using two superposed series of transverse back-and-forth continuous sutures, the diaphragm is invaginated, then stretched. The first suture line holds the diaphragm down and maintains the excess within the abdomen; the second suture line places the desired tension on the diaphragmatic dome. Successful repair of 3 cases by this technique is described.

Adult↗
PubMed1996

Postpneumonectomy syndrome with an ipsilateral aortic arch after left pneumonectomy.

BACKGROUND: Previous reports have described bronchial obstruction after left pneumonectomy (so-called post-pneumonectomy syndrome) in the presence of a right aortic arch with the bronchus being compressed between the ascending aorta and thoracic spine. This study reports on 4 patients with left postpneumonectomy syndrome in the presence of a normally located left aortic arch and ascending thoracic aorta. METHODS: The case histories of 4 patients with this syndrome were reviewed and several features common to all 4 were noted. In each case, the obstruction was thought to be due to a clockwise rotation of the mediastinum with bronchial compression occurring between the right main pulmonary artery and thoracic spine. RESULTS: Three patients were treated by repositioning of the mediastinum, and all 3 obtained relief of their dyspnea. In these cases, permanent repositioning was ensured by the insertion of a prosthesis filled with saline solution. The fourth patient was successfully treated by resection of a portion of the adjacent thoracic vertebra. CONCLUSIONS: Postpneumonectomy syndrome can occur after a left pneumonectomy in the absence of a right aortic arch. We suggest that mediastinal repositioning with a prosthesis filled with saline solution is simple, is safe, and results in complete relief of preoperative symptoms.

Adult↗
PubMed1996

History of surgery for emphysema.

Throughout the 20th century, several operations have been advocated as methods of treatment for patients with emphysema and, often, they were promoted as offering potential cures. Unfortunately, most of these procedures attempted to treat the wrong physiological or anatomic deficit so that mid- or long-term results were unpredictable or frankly disastrous. Procedures such as costochondrectomy were designed to permit further enlargement of the lungs, whereas thoracoplasty was designed to reduce lung volume. Operations were performed to restore the curvature of the diaphragm or devised to increase blood supply to the lung. Almost every thoracic structure including chest wall, diaphragm, pleura, nerves, airways, lung, or esophagus became "at risk" for surgical intervention. Short of bullectomy for emphysematous bullous lung disease and perhaps volume reduction for diffuse emphysema, none of these procedures has stood the test of time.

History, 20th Century↗
PubMed1995

Lobectomy in the treatment of the scimitar syndrome.

The scimitar syndrome is a congenital anomaly that consists mainly of total or partial anomalous venous drainage of the right lung to the inferior vena cava. We report the case of an 8-year-old girl diagnosed at birth as having a scimitar syndrome and who presented with recurrent right lower lung infections. She underwent resection of the lower half of her right lung without diversion of the anomalous venous drainage of the upper portion of the lung. She improved rapidly postoperatively and the shunt fraction diminished.

Child↗
PubMed1995

Sleeve pneumonectomy.

Occasional tumors arising in the upper lobes or in the origin of either main bronchus are localized sufficiently to permit curative resection by sleeve pneumonectomy. Operative mortality is significant, but it can be lowered by careful attention to surgical and anesthetic techniques.

Bronchi↗
PubMed1995

A perspective on the role of surgery in chronic obstructive lung disease.

As can be judged by reading the description of these operations, much has been done throughout the twentieth century to try to improve the quality of life of emphysema patients. At the time of their description, all procedures were based on what appeared to be clear understanding of the pathogenesis of the disease, and all were championed by leading surgeons, mostly in Europe and in the United States. Early results were always encouraging, but the severity of emphysema and the wrong understanding of the problem were the limiting factors for sustained good results. In addition, clinical and functional results of surgery were difficult to assess because all reported series were small and inconsistent, and because no controlled trial was ever done to compare the results of standard medical therapy with that of surgery. It is also clear that the general failures of surgery to predictably improve dyspnea in emphysematous patients relates to the nonavailability of an experimental model in which physiologic parameters of success could be evaluated.

Humans↗
PubMed1995

Indications for surgery and patient work-up for bullectomy.

Bullectomy can be associated with significant improvement in dyspnea as long as patients are appropriately selected. This selection process begins with clinical history and determination of the size and location of the bulla. If a patient has a smaller bulla, which is less than 30% of the volume of the hemithorax, the dyspnea is unlikely to be related to the bulla and its excision is probably not indicated. Laros et al determined that for successful bullectomy, the bulla must occupy at least 50% of the hemithorax and show definite displacement of adjacent lung tissue. In addition, there must be no vanishing lung syndrome nor chronic purulent bronchitis. Wesley et al added that there should be radiologic evidence of compressed lung tissue that can be re-expanded by removal of the bulla, and that there should be evidence of regional imbalance with poor perfusion on the side of the bulla and relatively good perfusion on the contralateral side.

Humans↗
PubMed1994

Prospective assessment of 30-day operative morbidity for surgical resections in lung cancer.

Prospective morbidity and mortality rates associated with resection of lung cancer that are reflective of the current trend toward preoperative therapy are not readily available in the current literature. To determine their prevalence, we prospectively analyzed the results of 783 resections performed within contributing Lung Cancer Study Group (LCSG) centers. There were 543 men and 240 women with a mean age of 63.44 years. Of the 783 resections, there were 411 lobectomies, 135 pneumonectomies, and 237 other procedures. Thirty patients died postoperatively (mortality, 3.8%) and 211 had a major complication (27%). Complications occurred more commonly in men (34.3%, p = 0.001), in patients age 60 or older (34.0%, p = 0.001), and in patients with a Karnofsky index < 9 (44%, p < 0.001). There was no significant difference between mortality, significant morbidity rates for lobectomy (28.2%), and pneumonectomy (31.9%), or for simple (28.3%) and extended resection (31.9%). The seemingly higher incidence of major postoperative events reported in this series not only reflects the prospective nature of this analysis but also the fact that over 25% of patients were in other therapeutic trials involving neoadjuvant or postoperative adjuvant regimens. Within that context, these data appear to be a reasonable estimate of modern surgical morbidity rates in the treatment of lung cancer.

Aged↗
PubMed1994

Management of bullous disease.

Although emphysema is a "medical disease", the removal of large bullae may be beneficial to some patients. Selection for surgery should be based on careful clinical, anatomic, and functional evaluations. Unfortunately, no single preoperative test is considered to be an accurate predictor of improvement. Additionally, the natural history of unresected bullae is poorly understood because some lesions increase rapidly, whereas others remain unchanged for long periods of time.

Emphysema↗
PubMed1994

Lung tumor resection does not affect debrisoquine metabolism.

Some authors have reported an association of extensive metabolism of debrisoquine with increased lung cancer risk, although others have found no association. Debrisoquine metabolism is controlled by a cytochrome P-450 isozyme encoded at the CYP2D6 locus, which is inducible by antipyrine and rifampicin. Because lung tumors may produce a variety of humoral substances, we wanted to determine whether the tumor induced debrisoquine metabolism. As part of a case-control study of lung cancer, debrisoquine metabolism was measured in patients with histologically confirmed non-small cell lung cancer before and after surgical resection with curative intent. One hundred four incident patients with curative intent. One hundred four incident patients with pathological stage I, II, or IIIA non-small cell lung cancer took debrisoquine (10 mg) orally at 10 p.m. and collected the subsequent 8-h urine both before and after surgery. We compared the values of the metabolic ratio, which is the percentage of the dose excreted as debrisoquine to the percentage of the dose excreted as the principal metabolite. The pre- and postoperative metabolic ratios were highly correlated (Pearson correlation coefficient = 0.96), and did not differ in value significantly (P = 0.88). Using traditional cutpoints (metabolic ratio, 1.0 and 12.6) to categorize the three metabolic phenotypes, the preoperative and postoperative phenotypes were well correlated (kappa = 0.78). These results show that the ability to metabolize debrisoquine is not induced by the presence of a primary lung tumor.

Carcinoma, Non-Small-Cell Lung↗
PubMed1994

Survival related to nodal status after sleeve resection for lung cancer.

Sleeve lobectomy is a lung-saving procedure indicated for central tumors for which the alternative is a pneumonectomy. The relation between survival and nodal status is controversial because, in most series, the presence of N1 disease adversely affects the prognosis with few or no long-term survivors. During the period 1972 to 1992, 142 patients underwent sleeve resection for lung cancer at our institution. Mean age (+/- standard deviation) was 60.7 +/- 9.1 years (range 11 to 78 years), and indications for operation were a central tumor in 112 patients (79%), a peripheral tumor in 18 patients (13%), and compromised pulmonary function in 12 patients (8%). Histologic type was predominantly squamous (72.5%) followed by nonsquamous (24.6%) and carcinoid tumors (2.8%). Resection was complete in 124 patients (87%) and incomplete in 18 (13%), and the operative mortality was 2.1% (n = 3). Follow-up was complete for the 139 remaining patients. Including operative deaths, survivals at 5 and 10 years for all patients were 46% (95% confidence intervals 38% to 55%) and 33% (95% confidence intervals 24% to 42%), respectively. For patients with N0 status (n = 73), 5- and 10-year survivals were 57% (95% confidence intervals 45% to 69%) and 46% (95% confidence intervals 32% to 60%); for patients with N1 status (n = 55), these rates were 46% (95% confidence intervals 32% to 60%) and 27% (95% confidence intervals 14% to 40%) (p = 0.13). No patient with N2 status (n = 14) survived 5 years. Local recurrences occurred in 23% of cases, but the prevalence was not statistically different between patients with N0 disease (16.6%) and N1 disease (23.1%) (p = 0.43). These data suggest that sleeve resection is an adequate operation for patients with resectable lung cancer and N0 N1 status. The presence of N2 disease significantly worsens the prognosis and may contraindicate the use of the procedure.

Adolescent↗