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Biomedical subjects

J M Velardocchio

Publications and source records attributed to J M Velardocchio.

10 recordsLinked to original sources
PubMed1984

[Value of thoracoscopy].

Formerly used in active tuberculosis to divide pleuro-pulmonary adhesions and to complete therapeutic pneumothorax, thoracoscopy has now become the object of renewed interest. By introducing, after pneumoserosa and usually through the axilla, a fine trocar into the chest, the whole thoracic cavity, including parietal pleura, diaphragm, lung and lung fissures, mediastinum and pericardium, can be explored. This technique, performed under local rather than general anaesthesia or under neuroleptanalgesia, is innocuous, fairly cheap and effective. In addition, the patient is immobilized for only 4 or 5 days on average and surgery, which is much heavier, can be avoided in many cases. Thoracoscopy nowadays is mostly used: (1) to determine the cause of a chronic pleurisy unexplained after 3-4 weeks (positive results: 95-97% for cancer, 92% for tuberculosis); (2) to dry up pleural effusions by talc and drainage (satisfactory results in 90% of the cases); (3) to establish the pathophysiological diagnosis of spontaneous pneumothorax (bullae, blebs, adhesions, fistulae), to treat it with talc and with coagulation of small "bullae", or to decide in favour of surgery; (4) to perform lung biopsies which clinch the diagnosis in 95-97% of cases of diffuse interstitial pneumonia. The same technique is also used methodically and efficiently for optic and electronic microscopy, bacteriological or mycological examination, immunofluorescence, hormone receptor detection and study of organic particles or minerals. Thoracoscopy lies half-way between pure medical practice and surgery and deserves to be widely used again by pneumologists, provided they learn to master its technique by regular, assiduous and sufficient practice. Pneumologists do not become thoracoscopists at a moment's notice; it is a skill which must be included in their training.

Anesthesia↗
PubMed1984

[Diagnosis of localized pulmonary opacities by transbronchial biopsy].

In order to assess the value of transbronchial biopsy (BTB) in the diagnosis of local pulmonary opacities, we have carried out a prospective study from October 1981 to August 1982 on 180 patients with a localised pulmonary opacity radiographically. 73 presented with a tumour visible fibreoptically in whom the diagnosis was made by bronchial biopsy. In 56 patients the clinical and biological picture were not suggestive of a malignancy and the lesion disappeared in 15 days on antibiotic treatment. Finally in 51 subjects the cancerous nature of the opacity was strongly suspected and the indication for a BTB were met. We obtained the following results: among 51 patients 11 were suffering from the sequelae of non-progressive disease and 40 of progressive disease; namely a sensibility of 80% and a specificity of 100%. The results vary as a function of the size of the tumour and its localisation. The best results were obtained for tumours with a diameter of greater than 3 cm, in the middle third of the lung (diagnosed by BTB 9 times out of 10). Thus transbronchial biopsy seems to be the first invasive examination to contemplate in the diagnosis of localised pulmonary opacities.

Adenocarcinoma↗
PubMed1980

[Respiratory function profile in scleroderma. 20 cases (author's transl)].

This study involved 20 patients, 13 female and 7 male, with a mean age of 49 years, suffering from localized (6 cases) scleroderma or generalized without Raynaud's syndrome (6 cas), with Raynaud's syndrome (6 cas) or acrosclerosis (2 cases). Respiratory function tests included study of volumes, flow rates, CO transfer (TLCO) and blood gases. There were 38% normal chest X-rays, 58% ventilatory disturbances (predominance of restrictive syndrome and decrease in (TLCO) was found in only 25% of cases. The authors emphasize the extent of pulmonary vascular lesions in these patients.

Adult↗
PubMed1979

Bronchodilator effects of antiasthmatic cigarette smoke (Datura stramonium).

In 12 asthmatic patients with mild airway obstruction we have measured the effect on specific airway resistance (sRaw) of inhaling the smoke of one Datura stramonium cigarette. In 11 patients sRaw decreased substantially after the cigarette, the mean maximal decrease being 40% at the 30th minute. In seven patients the subsequent inhalation of 200 micrograms salbutamol caused no further decrease in sRaw. In the remaining four patients salbutamol induced a larger decrease in sRaw than the cigarette smoke. The inhalation, however, of a synthetic anticholinergic agent (SCH 1000, 600 micrograms) proved as effective as salbutamol in these patients. In one patient the cigarette smoke and SCH 1000 produced only a negligible amount of bronchodilatation whereas the bronchial obstruction was reversible with salbutamol. Minor side effects were observed in six patients after the cigarette.

Adult↗
PubMedDate not supplied

Comparative reflex action of histamine, acetylcholine and serotonin on dog airways.

To dissociate airway stimulation from airway response, a segment of the cervical trachea was isolated from the rest of the bronchial tree in 15 anesthetized dogs; nerve and blood supplies of the segment were preserved. Patency of the intrathoracic airways was assessed with lung resistance (RL) measurements. When doses of aerosolized histamine (His), acetylcholine (ACh) and serotonin (Ser) causing comparable increases in RL were delivered into the intrathoracic airways, concomitant increases in pressure were recorded in the tracheal segment (indicating constriction) with His being the most effective. When the hypoxemia accompanying His- and ACh-induced bronchoconstriction was prevented by inhaling an air-oxygen mixture, the tracheal response persisted (2 dogs). Vagotomy decreased the RL response to His, ACh and Ser and abolished tracheal response (13 dogs). The tracheal response was still abolished when larger doses of His and ACh were given in order to induce an increase in RL similar to that observed before vagotomy (7 dogs). These data suggest the existence of a positive feed-back mechanism in the airways, pharmacological bronchoconstriction causing vagally mediated reflex bronchoconstriction. Direct stimulation of lung irritant receptors by histamine may explain the larger degree of reflex bronchoconstriction observed with this agent.

Acetylcholine↗
PubMedDate not supplied

[Pleural pressure during thoracocentesis in patients with pleural neoplasms].

In 45 patients with cancerous pleural effusion, thoracocentesis was performed according to the following technique : after local anaesthesia (5 ml of 2% lidocaine) in the posterior part of the 6th intercostal space, thoracocentesis was carried out with a blunt trocar connected to a water manometer. The pleural pressure was measured before removal of the fluid (Po). Then three different techniques of drainage (active suction at -- 80 or -- 40 mmHg or underwater sealed drainage) were randomized. Pleural pressure was measured after removal of every 100 ml and at the end of the procedure (PT). The mean Po +/- SD was respectively -- 4.08 +/- 2.95, -- 3.81 +/- 3.12 and -- 2.53 +/- 2.42 cmH2O for the three different groups of drainage. After drainage, PT was decreased in the three groups, especially after -- 80 mmHg aspiration. In 14 patients, side effects occurred during thoracocentesis and the procedure was stopped. Symptoms, chiefly cough, occurred after a mean removal of 1.1 +/- 0.7 1. PT in these patients was statistically lower (-- 18 +/- 5.59 cmH2O) than in the 31 asymptomatic patients (--11.40 +/- 5.75 cmH2O) (p less than 0.001). In conclusion, the assessment of the pleural pressure during thoracocentesis seems to be convenient in order to prevent any complication of pleural evacuation : pleural evacuation should be stopped if the pleural pressure decreased below -- 18 cmH2O. A depression at -- 80 mmHg is too dangerous for pleural aspiration; -- 40 mmHg or under water sealed drainage are both convenient for a safe and complete evacuation.

Aged↗
PubMedDate not supplied

[Clinical aspects and course of 38 cases of malignant pleural mesothelioma observed in the Marseilles region].

Epithelial or mixed mesotheliomas were detected in 38 patients in the region of Marseilles over a period of 9 years. Though an occupational element was involved in 80% of cases, no history of contact with asbestos could be obtained in certain of the patients. Confirmation of diagnosis requires wide pleural biopsies, because of the high level of false negatives and false positives from cytology and pleural needle biopsy. Hyaluronic acid levels are significant only when they are markedly enhanced. Local and regional tumor spread provides an aid to prognosis, but authentic metastases, with further worsening of prognosis, were detected in more than 75% of patients while still alive. Nodules appeared along the course of punctures of drainage tubes or in thoracotomy scars in 56% of cases, and appear to be a very frequent and characteristic feature of mesothelioma. Their therapy involves preventive irradiation.

Adult↗