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Biomedical subjects

J F Velly

Publications and source records attributed to J F Velly.

At least 55 records · Page 3Linked to original sources
PubMed1991

[Tracheobronchial healing in lung or heart-lung transplantation. An anatomical study of forty anastomoses in men].

The post operative evaluation and endoscopic follow-up of 34 tracheal or bronchial anastomoses after lung or heart-lung transplantation show some aspects of the tracheobronchial healing and difficulties in the healing process: primary type I mucomucosal healing in only 6 cases, secondary type II mucosal healing in 15, delayed type III healing after mucosal or deep parietal necrosis in 13, type IV distant ulcerations of mucosa and spur lesions in 12. Type III difficulties of healing mainly occur after double-lung transplantations which always suffer from ischemia. Autologous tracheal or bronchial sutures in 3 transplanted patients submitted to standard immunosuppressive therapy including corticosteroids were uneventful and type I. This experience suggests that among all factors having an influence on bronchial healing, ischemia of the donor tracheobronchial tree is predominant, justifying all attempts of bronchial revascularization after double-lung transplantation. The efficacy of the arterial revascularization is verified in 3 cases of tracheal anastomosis after double-lung transplantation with type I or II tracheal healing.

Anastomosis, Surgical↗
PubMed1991

[Simultaneous tracheal resection-anastomosis and heart transplantation].

Advanced myocardial disease associated with a post-intubation tracheal stenosis due to acute cardio-pulmonary failure in a 52 year-old patient led to a difficult choice of priorities between tracheal resection-anastomosis and heart transplantation. A simultaneous surgical operation with both heart transplantation and tracheal resection-anastomosis was considered to be a safe solution and was performed successfully. No adverse effect of corticosteroid and immunosuppressive therapy was observed on tracheal healing despite the tension resulting from segmental resection of the trachea.

Anastomosis, Surgical↗
PubMed1990

The growth of circumferential scars of the major airways from infancy to adulthood.

The factors affecting the development and prognosis of scarred airways in children are presented from a long-term follow-up study of 14 cases of tracheobronchial lesions following either injury or operation. Four children managed by endoluminal treatment developed severe stenosis and required treatment, later as adults, by laser resection in 2 cases and by laryngotracheal plastic enlargement and resection with anastomosis in 1 case each. The follow-up of 7 children managed by plastic procedures showed inconsistent results: they were good or excellent in 3 cases but with a decrease in the laryngotracheal diameter of 36%, 28% and 7% respectively. The laryngotracheal calibre decreased in 2 patients to 45% due to partial fibrous stenosis. Resection and anastomosis was required in the remaining 2 patients after 11 and 12 years for severe re-stenosis. The 3 patients who underwent immediate surgical resection all had an excellent clinical and morphological result, with a decrease in the laryngotracheal diameter of only 7%, 13% and 19% after a follow-up of 18, 20 and 15 years, respectively. These results show that the growth capacity of scars in children's airways is closely related to residual sclerosis following the initial treatment. It is thus suggested that primary resection and anastomosis should be performed in as many cases as possible. In the performance of plastic procedures, special attention should be paid to complete resection of the fibrotic tissues. Finally, a very long postoperative follow-up is always required in children in order to assess the development of the airway.

Adolescent↗
PubMed1990

Lung and heart-lung transplantation for end-stage lung disease. The Bordeaux Lung and Heart-Lung Transplant Group.

Between February 1988 and December 1989, 15 combined heart-lung, 2 double lung and 5 single lung transplants were performed at our institution for end stage lung disease. The indication for heart-lung transplantation was primary lung disease with associated secondary heart failure in 11 cases, diffuse pulmonary disease with extensive adenopathy of the hilum in 2 cases and profuse and antibiotic-resistant tracheobronchial infection due to Pseudomonas in 2 cases. A double lung transplant was performed in 2 patients with hypertensive emphysema. The indication for a single lung transplantation was emphysema in 2 cases and pulmonary fibrosis in 3 cases; in this last indication, transplantation should be performed on the right side with a slight lengthening of the main bronchus to avoid the side-effects of mediastinal shift. There were 2 early deaths, 7 secondary deaths (from the 2nd to the 5th month) due to viral or bacterial infectious complications, and 1 late death in the 7th month (infection due to a syncitial virus). All 12 surviving patients have an excellent functional result; the size of the tracheal or bronchial anastomosis ranges from 85% to 100% of normal. From this experience, we conclude that specificity and severity of lung hazards are mainly related to bronchial infection, dependence on steroids and pleural adhesions. Moreover, posttransplant pulmonary oedema, mucociliary dysfunction and the differential diagnosis between rejection and infection require careful endobronchial suction and periodical sampling.

Adult↗
PubMed1990

[Perforation and rupture of the esophagus. Apropos of 35 cases].

A series of 35 oesophageal perforations from the period 1980-1987 is reported. Sixteen perforations followed oesophageal endoscopy, 10 were spontaneous, 8 were due to foreign bodies and one was post-operative. The delay in reaching the right diagnosis was less than 24 hours in 18 cases and more than 24 hours in 17 cases. Oesophageal leak was demonstrated in 86% of our cases by contrast study; in the others by rigid oesophagoscopy. Perforation occurred in the cervical oesophagus in 6 patients, thoracic oesophagus in 28 and abdominal oesophagus in 2 (one had a double perforation). Three patients were managed non operatively and survived. Cervical oesophagostomy and oesophageal diversion were used in 4 patients as primary treatment because of perforation occurring in caustic burn cases (2 cases, both survived) or late severe sepsis (2 cases, both died). Two patients with neoplastic stricture were treated by oesophago-jejunal bypass without resection and partial oesophago-gastrectomy respectively: both survived. Direct suture and closure of the perforation were performed in 26 patients. Two died, one because of oesophageal leak. Post-operative localized leaks developed in 5 other patients without any mortality and 4 healed with conservative management. The overall mortality rate was 11% (4 patients). All had a delayed diagnosis (more than 48 hours). We suggest that even in patients with delayed diagnosis of a non-malignant oesophageal perforation, direct suture and closure should be attempted under protection of functional oesophageal diversion and "contact drainage" to canalize a possible post-operative localized leak. Good oesophageal diversion can be achieved by naso-oesophageal suction and gastric suction through gastrostomy or with oesogastric antireflux procedure.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Contribution of x-ray computed tomography and MRI to the surgical diagnosis of bronchial cancers. Comparative evaluation of x-ray computed tomography, MRI and thoracotomy in 111 cases].

Computed tomography and magnetic resonance imaging have respectively decreased the incidence of exploratory thoracotomy by 11.6% to 5.7% then 5.3% after their successive inclusion in the assessment of the operability of lung cancers. Based on a systematic comparison of CT and MRI with exploratory thoracotomy in 111 patients, the yield, sensitivity and positive predictive value of these examinations was assessed in relation to tumour extension to various sites: to the chest wall, for which the sensitivity was poor (38% for CT, 54% for MRI) with a moderate predictive value (71% for CT, 77% for MRI); to the mediastinum with improved sensitivity (69% and 72%) but an uncertain predictive value (61% and 72%). The sensitivity and predictive value were then measured for lymph node involvement: N1: moderate sensitivity (69% and 76%) but a good predictive value (95% and 92%); N2 and N3: good sensitivity (79% and 93%) but a poor predictive value (70% and 66%). Apart from a few particular indications specific to MRI, especially in the apex, left hilum and in contact with the atrium, the efficacy of these two investigations is very similar. However, their lack of specificity means that certain exploratory thoracotomies are still justified in order to assess the operability of the tumour. A surgical or mediastinoscopic anatomical assessment is still necessary for a good classification of lymph node extension of lung tumours.

Carcinoma, Bronchogenic↗
PubMed1989

Post traumatic disruption of the laryngo-tracheal junction.

Of 43 tracheo-bronchial ruptures, 19 patients presented with disruption of the laryngo-tracheal junction which would appear to be a very specific anatomical lesion. The disruptions were secondary to blunt cervical trauma in 11 cases and strangulation in 8 cases. The disruption was complete in 14 cases and incomplete in 5. The lesion is very complex and involved the retraction of the lower part of the trachea into the mediastinum (14 cases), fracture of the cricoid ring (9 cases), bilateral recurrent nerve tears (14 cases), unilateral (4 cases) and retraction of the laryngeal mucosa with exposure of the cricoid cartilage in all cases. According to the complexity of the lesion, the treatment was: laryngo-tracheal resection and end-to-end anastomosis with treatment of the vocal cord palsy in 13 patients; simple end-to-end anastomosis in 4 patients who had an unilateral vocal cord palsy; 2 patients with a partial disruption were treated medically with endoscopic stenting and laser photocoagulation. All had restoration of airway patency and recovery of voice. The results contrast with the failures and reoperations reported in the literature and underline the necessity of complete evaluation and treatment of these complex lesions.

Adult↗
PubMed1989

Experience of partial oesophagectomy in surgical treatment of lower and middle thoracic oesophageal cancer. From a follow-up of 366 cases.

Since carcinoma of the oesophagus is considered to be frequently multicentric, total oesophagectomy appears the only radical therapeutical approach. A follow-up of 366 patients who underwent partial oesophagectomy shows that this procedure can be curative as well as palliative and is sometimes the only procedure possible with a reasonable mortality. These patients had an oesophageal carcinoma located between the cardia and the level of the aortic arch (60.5% squamous, 37% adenocarcinoma). Of these, 22% were over 70 years of age. The surgical route was a left thoracotomy in 280 cases (with anastomosis below or above the aortic arch) or a laparotomy and right thoracotomy in 86 cases. The oesophagus was transected as high as possible and replaced by an isoperistaltic tube fashioned from the greater curvature of the stomach. Mediastinal tissues and the lesser curvature with their lymph nodes were removed. The overall operative mortality was 7% (4% in patients less than 70 and 15% over 70). Very few anastomotic fistulae were observed (6 cases) but they were always severe (6 deaths). The middle and long term results show acceptable functional sequelae and a good survival quality. The survival is 57% at 1 year, 30% at 3 years and 23% at 5 years (27% when the excision appeared curative). There was no significant difference in survival for patients whose cancer was in the mid-oesophagus compared to the lower oesophagus. There was no difference in survival in the cell type squamous or adenocarcinoma. Death was mainly due to metastatic lesions and mediastinal lymphatic recurrence.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1989

[2 cases of pulmonary excision in patients with acquired immunodeficiency syndrome. What is the role of surgery in AIDS?].

The authors report two cases of lung resection in patients with AIDS: left upper lobectomy for diagnosis and treatment of an active, localized lung lesion which proved to be tuberculosis and atypical resection of the right apex and pleurodesis for an infected pneumohydrothorax. The postoperative course was uneventful despite the fragile clinical context. The place of surgical indications for diagnostic purposes is reduced by the good results obtained with endoscopic investigations and limited to failures of these procedures and to pulmonary sarcomatous lesions. The place of therapeutic surgical indications is essentially reserved for pleural complications (pleurodesis, pleurectomy, pleurotomy). Surgery may be unjustified in tracheostomised patients at the stage of respiratory failure. It may have a small but effective role with reduced risk in active, localized lung lesions. The surgery must be performed according to simple and classical by very rigorous rules of protection for the operators and the environment.

Acquired Immunodeficiency Syndrome↗
PubMed1989

[Lung and heart-lung transplantation in respiratory tract diseases. Evaluation and development of the indications based on our first 15 cases].

Since January 1988, the Bordeaux group has performed 15 transplantations for lung disease: 9 heart-lung transplants, 1 heart + left lung, 1 double lung, 2 right lungs and 2 left lungs. The transplantations were performed for pulmonary emphysema (10 cases), pulmonary artery hypertension (2 cases), cystic fibrosis (1 case), pulmonary fibrosis (2 cases). Cardiopulmonary transplantation was not always performed because of associated heart failure but sometimes because of large intrahilar adenopathy or intractable bronchial infection. Pulmonary transplantation is recommended on the right side in cases of pulmonary fibrosis. One patient died postoperatively (ischaemia of the transplant). Four others died during the 2nd and 3rd months from poorly defined but probably infectious pulmonary syndromes. The tracheobronchial patency of the 10 survivors was 80% or 100% of the predicted value. The respiratory functional result was excellent in the short and intermediate term. Specific difficulties essentially consisted of pleural symphyses, hilar adenopathy, bronchial infection, steroid dependence of certain subjects, the difficulty of identifying the cause and treating lung opacities during the 2nd and 3rd months.

Anastomosis, Surgical↗
PubMed1989

[Treatment of esophagotracheal fistula following intensive care. An experience of 17 cases].

Oesophago-tracheal fistulae secondary to respiratory intensive care have become the commonest type of non-tumoural fistula in adults: 17/26 cases. They complicated a long period of difficult and septic intensive care, after a mean interval of 30 days. The diagnosis was confirmed by bronchoscopy which also provided good assessment of the site and extent of the fistula and the associated tracheal lesions. The severity of this complication is stressed by 5 deaths in the present series (1 toxi-infectious syndrome after 24 hours, 2 abandonments due to a hopeless resuscitation prognosis, 2 cases of oesophago-tracheal reflux which could have been prevented). One should not wait for spontaneous cure (although this did take place in 2 cases). Ideal direct suture (9 cases: 9 cures) requires local conditions favourable for healing and rapid respiratory autonomy. These conditions can be achieved by an active approach to protection against oesophago-tracheal reflux: at least lower oesophageal exclusion (4 cases) by ligation or anti-reflux operation. Oesophageal exclusion followed by oesophago-coloplasty is sometimes the only solution in cases of severe destruction of cervico-mediastinal tissues (2 cases: 1 cure). Five tracheal strictures required an associated resection-anastomosis (5 cures).

Adult↗
PubMed1989

[Value and current role of anterior mediastinotomy in the diagnosis of mediastinal diseases. Apropos of a series of 100 cases].

One hundred anterior mediastinotomies performed between 1981 and 1987 resulted in the diagnosis of 90 malignant mediastino-hilar or anterior mediastinal tumours, 4 benign lymph node diseases and 6 non-specific lesions. This easy to perform biopsy technique was followed by low morbidity (7%) and one death after 48 hours due to major mediastinal compression. Its sensitivity and specificity make it a valuable alternative and, according to the authors, preferable to mediastinoscopy in the diagnosis of tumours of lymph node diseases in the anterior, pulmonary hila, especially on the left side, and anterior mediastinal lymph node chains.

Adolescent↗
PubMed1988

The surgical treatment of inflammatory and fibrous laryngotracheal stenosis.

Seventy-two patients with laryngeal or laryngo-tracheal stenotic lesions resulting from tracheal intubation or laryngo-tracheal injuries are reported. Prior to 1978, the method of surgical treatment consisted mainly of laryngoplasty supported by laryngeal stenting. Twenty-six patients were treated by this method with 2 mortalities. Twenty-one long term results were good and 3 were fair. After 1978, laryngo-tracheal resection was performed in 46 patients. Twenty-seven had a Pearson-type operation, 13 underwent total or subtotal cricoid plate resection and modelling, and the remaining 6 had modelling alone. Perfect results after resection depend on the treatment of infection and inflammation of the airway before surgery. Our preferred method is resection and end-to-end anastomosis whenever possible. In addition to the anatomical site of the lesion, the glottic opening has to be considered in planning the surgical operation since impairment necessitates enlargement of the glottis as part of the procedure.

Adolescent↗
PubMed1988

Bronchogenic carcinoma staging: CT versus MR imaging. Assessment with surgery.

One hundred and twenty patients with bronchogenic carcinoma were prospectively studied by both computed tomography (CT) and magnetic resonance imaging (MRI) during the 2 weeks preceding thoracotomy or mediastinoscopy. MRI scans included contiguous axial and coronal slices. Results of CT and MRI studies were compared with the surgical and pathological findings on the basis of the TNM classification. Although no significant difference was found between the two imaging methods for the evaluation of tumour extent, MRI appears to be a valuable imaging technique for left upper lobe and apical neoplasms. Comparison between the two techniques for mediastinal node evaluation showed that sensitivity of MRI is superior to CT in the left paratracheal, aortopulmonary and subcarinal node areas.

Adult↗
PubMed1985

Current reconstructive management of subglottic stenosis of the larynx with reference to sixty consecutively treated cases.

Sixty patients with subglottic stenosis of acquired and nonneoplastic origin were surgically managed by multiple open procedures. Follow-up ranged from 1 to 10 years. Fifty-seven patients had stable and excellent or good results, 2 of them after further surgery, 1 patient had to live with a retained tracheostomy indefinitely and the remaining 2 patients died. While the whole spectrum of surgical modalities employed in this series may not be recommended with total conviction, the authors express their satisfaction with single resection and end-to-end anastomosis which yields invariably good and rapidly obtainable results (22 cases with complete success). Nevertheless, laryngeal enlargement seems to be essential in the case of upper glottic lesions (19 operations provided 19 successes) while primary resection with moulding plasties may be applicable to complex and extended stenoses (19 operations: 16 successful results and 3 failures). With regard to the choice of operation, the authors emphasize the importance of careful preoperative assessment of the lesions which should assure adequate selection of therapeutic methods according to the degree of associated involvement of the trachea, glottis or supraglottic area. Conservative measures including dilatation, electro-coagulation and laser-beam surgery are considered as palliative only, however, they may be useful either in the course of the patient's preparation or in order to achieve more successful postoperative results.

Adolescent↗
PubMed1984

[Endotracheal hemorrhage caused by fissuration of the innominate artery during prolonged intubation. Surgical treatment].

We present our surgical procedure for the control of tracheal haemorrhages due to fissuration of the innominate artery in patients with prolonged tracheal intubation or tracheostomy. Temporary haemostasis and protection of the airways against flooding are ensured by downward advancement of the tube, overinflation of the cuffs and digital pressure if required. The fistula is then located and surgical haemostasis is obtained by resection of the innominate artery away from the infected area. The arterial stumps are covered up for protection against secondary infection. Re-establishment of blood flow is not systematic. Cervicosternotomy is regarded as the incision of choice. No complication was encountered in patients treated by this method.

Brachiocephalic Trunk↗