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Biomedical subjects

J F Regnard

Publications and source records attributed to J F Regnard.

At least 55 records · Page 3Linked to original sources
PubMed1994

Lung resection after high doses of mediastinal radiotherapy (sixty grays or more). Reinforcement of bronchial healing with thoracic muscle flaps in nine cases.

Mediastinal radiotherapy of more than 60 Gy highly compromises bronchial and wound healing after lung resection. Nine patients with primary lung cancers underwent radical resection after high radiation doses. Eight patients had primary lung cancer previously treated by radiotherapy alone (n = 2) or associated with chemotherapy (n = 6). One patient had a tracheal cancer involving the carina that was previously treated by radiotherapy. Seven patients underwent pneumonectomy and one patient underwent lobectomy with reinforcement of bronchial stump closure with use of the serratus anterior muscle. One patient underwent a sleeve lobectomy with bronchial reconstruction wrapped with an intercostal pedicle flap. Five patients had no postoperative complications and four patients had empyema, one associated with a small bronchial fistula. All except one patient were successfully treated by thoracostomy and immediate or secondary transposition of the pectoralis major muscle and the omentum to fill the cavity. These results show that lung resections can be done after high doses of radiotherapy without a high rate of bronchial fistula by using thoracic muscle flaps to reinforce bronchial stumps and anastomoses. In this procedure, surgical dissection is more time-consuming and increases the postoperative empyema rate (4/9). However, the higher long-term survival may justify this choice in selected cases.

Adult↗
PubMed1993

Continuous intercostal analgesia with 0.5% bupivacaine after thoracotomy: a randomized study.

This study was undertaken to evaluate the effectiveness of 0.5% bupivacaine (360 mg/day) as a continuous infusion through an indwelling intercostal catheter inserted intraoperatively in the management of pain after thoracotomy. Eighty-six patients were randomized into three groups: group 1 = intercostal bupivacaine, group 2 = intercostal saline solution, and group 3 = fixed-schedule intramuscular buprenorphine. Supplementary buprenorphine was given as required. Pain and pulmonary function were assessed throughout the first 5 days after operation. Pain score was lower in group 1 than in group 2 for the first 8 hours after operation (p < 0.02). During the first 3 postoperative days, mean postoperative pain scores of 5 or more were recorded in 9% of group 1 patients versus 40% of group 2 patients (p < 0.05) and 13% of group 3 patients (not significant). Total doses of buprenorphine were lower in groups 1 and 2 than in group 3 (p < 0.001). No between-group differences in pulmonary function were observed. Respiratory complications occurred in no patients in groups 1 and 3 versus 5 in group 2 (p < 0.05). Continuous intercostal bupivacaine provided similar early pain control as compared with fixed-schedule narcotics but induced better analgesia with fewer complications than on-demand narcotics alone (group 2).

Analgesia↗
PubMed1993

[Prognosis of repetitive excisions of bronchial cancer].

The indications for repeated excision for bronchial cancer may be raised in cases of a synchronous second (or subsequent cancer) or in the case of a local recurrence of the initial cancer which was operated upon. Ninety consecutive patients had a repeat operation for cancer over a 30 year period. There were 86 men and 4 women with a mean age of 59. The initial cancer had most often been treated with lobectomy or bilobectomy and was relatively localised (90% stage I or II). However, 7 patients had a pneumonectomy. The repeat operation was carried out for 30 recurrences and in 44 for secondary subsequent cancers and in 16 cases for a bilateral synchronous cancer. The second operative intervention led to 30 pneumonectomies, 29 lobectomies and 20 atypical excisions. On the otherhand 11 patients had an exploratory thoracotomy and on 10 occasions there was local regional recurrence. These secondary localisations were classified as 44 stage I, 9 stage II and 26 stage III. Eight patients had major loss of lung parenchyma with a pneumonectomy on one side and an atypical excision or a lobectomy on the other. Six patients (6.5%) died in the post-operative period (two from respiratory failure and two due to cardiovascular causes and two sepsis). The actual survival at 5 years was 20% in cases that had an excision. The prognosis was identical in cases having a resection for a recurrence or for secondary subsequent cancer or for bilateral synchronous cancers.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1993

[Positioning of the patient for esophageal hiatus surgery].

A prospective study was conducted to determine the best position of patients undergoing esophageal hiatus surgery. Three positions were compared: 1) use of a cushion; 2) use of the operating table block, and 3) the ordinary supine position. Twenty-four consecutive patients undergoing surgical approach to the esophageal hiatus were placed successively in the three positions. The distance between the xiphoid process and the hiatus area was shorter in positions 1 and 2 by an average of 0.8 cm as compared with position 3 (p < 0.001). The angle determined by the xiphoid process and a horizontal line passing through the hiatas area was 14 degrees and 8 degrees, more when the cushion and the block were used, respectively, as compared with the supine position (p < 0.01). We recommend the use of the cushion in hiatal surgery, affording better exposure and therefore a more comfortable approach to the hiatal area as compared with the supine position.

Adolescent↗
PubMed1992

Primary lung cancer in young patients: a study of 82 surgically treated patients.

The aim of this study was to evaluate the prognosis for surgically treated young patients with primary lung cancer, a prognosis generally considered to be very poor. Eighty-two patients less than 40 years of age were operated on at Marie-Lannelongue Hospital between 1982 and 1990. There were 72 male and 10 female patients. Ten patients (12%) had never smoked, whereas 48 patients (59%) had smoked for more than 20 pack-years. The lung cancer was asymptomatic in 27 patients (33%) and symptomatic in the others. Adenocarcinoma was found in 42% of the patients, epidermoid carcinoma in 28%, mixed cell carcinoma in 16%, small cell carcinoma in 8.5%, and undifferentiated large cell carcinoma in 6%. Among the 69 resected tumors, 22 were stage I, ten were stage II, 32 were stage IIIa, and five were stage IIIb. The resection was considered complete and curative in 56 patients (68%) and noncurative in 26 (32%) either because of an incomplete resection (12 in stage IIIa; 1 in stage IIIb) or because of an exploratory thoracotomy only (13). The overall actuarial 5-year survival rate was 41%, and the actuarial 5-year survival for patients who had a complete resection was 56%. The actuarial 5-year survival rates were as follows: patients in stage I, 70%; stage II, 54%; stage IIIa, 28%; stage IIIb, 0%; and patients having exploratory thoracotomy only, 18%. These survival rates are similar to those of patients older than 40 years with similar stages of disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

Cancer surgery on a single residual lung.

A series of nine patients with single lungs operated on for lung cancer is reported. This represents 10% of all the synchronous and metachronous lung cancers operated during the same period. There were three early postoperative deaths and a further three patients died subsequently at 15, 20 and 24 months, respectively, after operation; the remaining three are alive 6, 12 and 29 months, respectively, following their surgery. The analysis of the results of this small series indicates that wedge and segmental resection, when feasible, may be undertaken in patients with a single lung with reasonable life expectancy. The fact that lobectomy is not tolerated in such patients emphasizes the importance of early diagnosis when minimal local excision can be undertaken.

Cause of Death↗
PubMed1992

Primary mediastinal germ cell tumors. Results of a French retrospective study.

Eighty-seven patients with primary mediastinal germ cell tumors treated between 1983 and 1990 were studied. Among the 23 patients classified as pure seminoma, eight (35 percent) underwent surgery followed by radiotherapy (n = 6), radiotherapy and/or chemotherapy (n = 2); two patients underwent radiotherapy; 13 patients (57 percent) underwent induction cisplatin-based chemotherapy (ten complete responses) followed by radiotherapy (n = 9), second line chemotherapy (n = 2) and surgical resection of residual tumor (n = 2). On completion of treatment, 22 patients (96 percent) with seminoma were free of disease. The two-year Kaplan-Meier survival rate of these patients was 86 percent. Among the 64 patients with nonseminomatous germ cell tumor, 19 patients (30 percent) underwent surgery as first treatment (ten complete resections) followed by chemotherapy (n = 17) and radiotherapy (n = 5). On completion of treatment, 12 of 19 patients were disease free. Forty-five patients (70 percent) underwent induction cisplatin-based chemotherapy (ten complete responses), and 22 of them underwent resection of residual tumor (19 complete resections). Twenty-three patients were treated with first line chemotherapy without postchemotherapy surgery (three complete responses). In summary, 33 patients (52 percent) with nonseminomatous germ cell tumors became free of disease, and seven patients (21 percent) relapsed after achieving a complete response. The two-year Kaplan-Meier survival rate of the nonseminomatous germ cell tumor patients was 53 percent (87 percent if a complete response), with a median survival of 28 months. Despite a worse prognosis than nonseminomaous tumors from other primary sites, this series of mediastinal germ cell tumors has confirmed the efficacy of therapy.

Adult↗
PubMed1992

[Mediastinoscopy in the evaluation of the extension of primary bronchial cancer. Techniques, indications and therapeutic deductions].

In order to achieve mediastinal lymph node staging in bronchial cancer, axial mediastinoscopy (combined with left anterior mediastinoscopy for cancers of the left upper lobe) is by far the most efficient and the most reliable technique. Since mediastinoscopy has been part of the investigations that can be made before thoracotomy, the number of exploratory thoracotomies has considerably decreased in all teams, thus reducing intraoperative mortality at the same time. Thoracic CT, which arrived in the diagnostic weaponry against lung cancer a long time after mediastinoscopy, has a major asset in that it allows selecting the patients for whom mediastinoscopy seems to be useful, on the basis of criteria related to the size of mediastinal lymph nodes (10 mm generally being the threshold chosen to perform mediastinoscopy or not). For almost all authors, systematic mediastinoscopy is no longer useful at present. Similarly, positive mediastinoscopic findings must not lead to systematically refuse patients, as the invasion or absence of invasion of a mediastinal lymph node is neither necessary nor sufficient to discuss a surgical indication. While some still automatically refuse all patients with positive mediastinoscopy, most authors still remain very interventionistic for N2 patients selected on the basis of very accurate criteria that are analyzed above, and surgery can then be performed at once or, for some authors, after a "neo-adjunctive" therapy, the long-term efficacy of which has unfortunately not been rigorously demonstrated as yet.

Bronchial Neoplasms↗
PubMed1992

Congenital respiratory-esophageal fistula in the adult. Report of nine cases and review of the literature.

Congenital tracheoesophageal or bronchoesophageal fistulas, if not associated with esophageal atresia, may not appear initially until adult life. Nine such cases (two tracheoesophageal and seven bronchoesophageal) are reported. The chief presenting symptoms were recurrent bouts of coughing, after drinking, and hemoptysis. In the majority of cases the duration of symptoms exceeded 15 years. The diagnosis was confirmed in seven patients by esophagography, in one patient by bronchoscopy, and in one patient the fistula was discovered incidentally during thoracotomy. The esophageal opening of the fistula was in the lower third in seven patients and in the middle third in two. Bronchoesophageal fistulas communicated with a segmental bronchus in four patients and with a main or lobar bronchus in three. Treatment involved excision of the fistula (five patients) or division and suturing (four patients). Postoperative follow-up revealed no long-term sequelae except persistent chronic respiratory failure in one patient. The respiratory failure had developed before treatment of the fistula. The analysis of this series and a review of the literature underline the high index of suspicion required in all cases of chronic cough and lung suppuration, to diagnose this benign condition before life-threatening complications occur.

Adult↗
PubMed1992

[Pulmonary and bronchial kinetics of cefuroxime after a single 500 mg intramuscular injection].

Thirty-two patients (28 males; mean age 56 +/- 10 years) who were undergoing bronchopulmonary exeresis surgery were included in this study of the pulmonary (pulm), bronchial (br), and plasma (pl) kinetics of cefuroxime after a single 500 mg intramuscular injection. Twenty-nine bronchial specimens and 38 pulmonary and plasma specimens were taken on average at the following times after the cefuroxime injection: 1 h, 2 h, 3 h, 4 h, 6 h, 8 h, and 10 h. Cefuroxime was assayed using HPLC on ground tissues, with a correction for contamination by blood. Peak concentrations (C) were found after one hour (Cpl = 11.6 +/- 0.8 micrograms/ml; Cpulm = 7.3 +/- 3.3 micrograms/g; Cbr = 3.7 +/- 1.5 micrograms/g) with the following residual values after 8 hours: Cpl = 0.94 +/- 1.04 micrograms/ml, Cpulm = 0.49 +/- 0.45 micrograms/g, Cbr = 0.15 +/- 0.07 micrograms/g (means +/- 1 SD). Elimination kinetics were monoexponential and similar in plasma, lung tissue and bronchial tissue (elimination half-lives: 1.74 h, 1.66 h, and 1.56 h, respectively), suggesting that all three elements belong to the same pharmacokinetic compartment. Mean intrapolated area-under-the-curve values (AUC) were 33.58 micrograms.ml-1.h (plasma), 20.08 micrograms.g-1.h (lung), and 10.22 micrograms/g-1.h (bronchus). The AUCpulm/AUCpl and AUCbr/AUCpl ratios were 0.60 and 0.30, respectively, in agreement with mean values of tissue level/simultaneous plasma level ratios (lung: 0.59; bronchus: 0.33).

Adult↗
PubMed1992

[Primary malignant germinal tumors of the mediastinum. Results from a national retrospective survey].

The object of this enquiry was to group together a series of patients with a mediastinal germ cell tumour who were diagnosed and treated between 1983-1990 to specify their clinical characters and their prognostic factors and to evaluate the current therapeutic strategies. Out of a total of 87 cases that were analysed 23 had seminomas and 64 malignant dysembryomas. Amongst the 23 patients suffering from seminomas, 8 had first been treated by surgery, 13 by chemotherapy and 2 by radiotherapy. At the end of treatment 22 made a complete response and 4 patients relapsed after 4-13 months following a complete response. 3 patients had metastases at the outset and were alive and in complete response at 1,4 and 7 years respectively. The survival level at 2 years for seminomas was 84%. Of 64 patients suffering from a malignant dysembryoma, 19 were first treated with surgery (10 by complete resection) followed by chemotherapy in 17 cases. At the end of treatment 12 patients were in complete remission. Only one of these patients had a subsequent relapse. 45 patients were first treated by chemotherapy (10 complete responses, 26 partial responses) then secondary surgery was performed in 22 cases, allowing a complete remission in 21. Seven malignant dysembryomas relapsed after an initial complete remission. The patients treated for pure choriocarcinoma were 7 in number: 6 of these received primary chemotherapy. One patient underwent a secondary resection and was living at 26 months. The other 5 died rapidly. The 2 year survival for malignant dysembryomas was 52%. The median survival was 28 months. There was a significant difference in surviyal between dysembryomas in complete remission and those in partial remission.

Adolescent↗
PubMed1991

[Pseudotumoral lipid pneumopathies. Apropos of six cases].

In cases of localised pneumonia due to oil aspiration, the diagnosis may be difficult and is often assessed by thoracotomy. Six cases of lung paraffinoma are reported. The lesion, localised in the lower lobe in five patients out of six, was discovered on screening chest x-rays. In two cases, two lesions were observed in the same patient. All six patients underwent lung resection. Diagnosis was made on histologic examination showing foreign body reactions against oil. Oil aspiration was due to oily nose drops in one patient and to the use of paraffin oil on a tracheostomy in two others. The preoperative diagnosis may be suspected on bronchial lavage CT scan and MRI. When the diagnosis is strongly suspected, thoracotomy can be avoided as in some cases withdrawal of the medication can be followed by progressive resolution of the radiological signs.

Aged↗
PubMed1991

[Pulmonary sequestration. Surgical aspects based on 61 cases].

Between 1955 and 1989, 61 patients (33 men, 28 women; mean age: 20 years) were operated upon for lung sequestration. Sequestration was intralobar in 49 cases and extralobar in 10 cases; both types were present in 2 cases. The abnormality was discovered by chance in 15 patients (24%). The most frequent clinical manifestations were those of recurrent bronchopneumonia (54%). X-ray films of the chest showed an apparently benign, posterobasal image in 88% of the cases. Arteriography was performed in 40 patients and revealed an abnormal systemic artery in 28. An abnormal artery was found by the surgeons and the pathologists in all cases. The intralobar type of sequestration was treated, by preference, by lobectomy, and the extralobar type by sequestrectomy. Problems were encountered in 5 cases: 2 wounds of an unrecognized artery and 3 difficult bleeding controls which required aortic clamping. The operative mortality was nil, and the morbidity rate was 5%. Computerized tomography and magnetic resonance imaging can confirm the diagnosis of pulmonary sequestration, but arteriography seems to be the best method to ascertain the diagnosis and guide the surgical procedure. Surgery is the rule in case of doubtful diagnosis or to treat symptomatic sequestration.

Adolescent↗
PubMed1990

[Rupture of the diaphragm of late manifestation].

Twenty one cases of delayed diagnosis of ruptured diaphragm caused by closed trauma are reported: 14 on the left side and 7 on the right side. The clinical signs and the modes of presentation are non-specific. Although the history of thoraco-abdominal trauma and the chest x-ray are sufficient to establish the diagnosis of rupture of the left hemidiaphragm, they can only suggest the diagnosis in cases of righ-sided rupture. The mechanism of rupture is more often due to sudden reflex contraction of the diaphragm against a closed glottis than to excessive abdominal pressure caused by the trauma. Diaphragmatic rupture due to closed trauma causes large tears exposing the patient to a low risk of strangulation of intestinal structures in contrast with ruptures due to a penetrating injury, which causes small tears. The diaphragmatic domes must be systematically explored during laparotomy or thoracotomy performed for thoraco-abdominal trauma.

Adolescent↗
PubMed1990

[Value of superior angiocardiography in the evaluation of the surgical excision of bronchial cancer. Respective role compared to thoracic x-ray computed tomography].

The place of angiography-superior vena cavography in the assessment of the resectability of a lung cancer must be defined in comparison with the data provided by thoracic computed tomography. Sixty-six patients with proximal lung cancers of doubtful resectability were studied by means of angiography and computed tomography and the results of these preoperative investigations were correlated with the operative findings. The sensitivity of these two examinations for the diagnosis of vascular invasion preventing pulmonary resection is poor (53% and 47% respectively). The specificity and positive predictive value of angiography appear to be slightly superior to those of computed tomography (Sp: 96% and 82%, PPV: 78% and 47%, respectively). The diagnostic performance of these two examinations remains poor. Magnetic resonance imaging may replace these two examinations in the future.

Carcinoma, Bronchogenic↗
PubMed1990

[Surgery of primary bronchial cancer. Different types of excisions: technical problems, follow-up results--status of pneumonectomies extended to the carina and bronchial resection-anastomoses].

Surgery is the best solution for primary lung cancer. Surgery must be very large when necessary and must be as limited as possible when pulmonary function is poor. Surgery obtains the best results in primary lung cancer but must be associated with adjuvant therapy when necessary and specially in N2 tumors. In our experience in Marie Lannelongue Center we operated 5890 primary lung cancers between 1966 and 1987 (2255 lobectomies and 2240 pneumonectomies). Our long-term results are 38% at three years and 31% at five years. Extended surgery has been done in many patients. Chest wall resection is used when necessary associated to the lung resection. Carina resection must be used also if necessary. In our experience of 46 pneumonectomies with carina resection the five-year survival is 20% and 41% only for the N1 tumors. When there is involvement of the mediastinal ipsilateral nodes we try to do surgery as often as possible (mediastinoscopy is used very routinely now). On 284 N2 primary lung tumors operated between 1982 and 1988 the five-year actuarial survival is 18%. When the pulmonary function is poor we perform lung lobectomies with sleeve resection (114 sleeve resections on the 2255 lobectomies). The postoperative morbidity and mortality is very low in our experience, and the five-year survival is very good (about 40%).

Anastomosis, Surgical↗
PubMed1989

[Epithelioid hemangioendothelioma of the azygos vein].

The authors report a case of epithelioid hemangioendothelioma of the azygos vein diagnosed during the investigation of a superior vena cava syndrome. Venography and thoracic CT and nuclear magnetic resonance scans showed an endovenous tumour with spinal and lymph node invasion. Cavographic-controlled biopsies allowed histological identification of the tumour. Palliative therapy consisted in tumour ablation and superior vena cava bypass. Epithelioid hemangioendothelioma is a rare vascular tumour characterised by the presence of epithelioid endothelial cells. It is slowly progressive and its potential malignancy justifies surgical excision whenever possible.

Azygos Vein↗