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Biomedical subjects

J Mouroux

Publications and source records attributed to J Mouroux.

At least 19 recordsLinked to original sources
PubMed2006

Comparison of the epidermal growth factor receptor gene and protein in primary non-small-cell-lung cancer and metastatic sites: implications for treatment with EGFR-inhibitors.

BACKGROUND: Very recent studies have suggested that EGFR gene copy number and expression obtained by fluorescence in situ hybridization (FISH) and immunohistochemistry (IHC) should be used to predict which lung cancer patients are expected to respond to anti-EGFR treatments. However, it is still not known whether EGFR expression differs in metastases compared to primary non-small cell lung cancer (NSCLC). PATIENTS AND METHODS: EGFR status was analysed by IHC and FISH on tumor samples of primary NSCLC and at least one distant metastatic lesion in 30 patients. RESULTS: Ten cases (33.3%) showed primary tumor/metastasis discordance by IHC analysis (n = 30): in seven cases, EGFR was expressed in the primary tumor but not in the metastasis, while three samples showed EGFR expression in the metastasis but not in the primary tumor (Pearson correlation coefficient = 0.331, P = 0.0074). By FISH (n = 26), seven (27%) cases were discordant: six cases showed a high-level of EGFR polysomy in the primary tumor but not in the metastasis and one case showed a high-level of EGFR polysomy in the metastasis but not in the primary sample (Pearson correlation coefficient = 0.52, P = 0.007). CONCLUSION: EGFR expression is not stable during metastatic progression in a significant proportion of NSCLC. These findings have to be considered in future prospective studies.

Adult↗
PubMed2006

["Therapeutic" pleural surgery].

Renewed interest in carcinological pleura surgery for the treatment of mesothelioma has resulted from an increased incidence of the tumor and also better control of postoperative mortality for an operation with a dramatic reputation. Techniques include pleurectomy, pleurodecrotication and wide pleuropneumectomy. To achive isolated resection of the parietal pleura or a combined resection of the parietal and visceral pleura with more or less wide resection of the diaphragm and pericardium. Indications depend on the tumor extension and the patient's status. Mortality, particularly for wide pleuropneumectomy is no well controlled by well-trained teams and is to the order of 5%. The rate of local recurrence is to the order of 10% and can warrant use of local treatments such as intrathoracic hyperthermic chemotherapy. Median survival for operated mesothelioma is 19 months with a 46% five-year survival for the tumors with the best prognosis. At the present time, radical surgical resection is the basis of local treatment for pleural mesothelioma.

Chemotherapy, Adjuvant↗
PubMed2006

Can intrapleural C-reactive protein predict VATS pleurodesis failure?

BACKGROUND: Intrapleural inflammatory reaction after surgery for spontaneous pneumothorax is a key indicator whether an effective pleurodesis has been achieved. In this study, we tested the hypothesis that intrapleural C-reactive protein (CRP) might precisely quantify the postoperative pleural inflammation, offering potentially useful information for patient management. METHODS: The study population consisted of 75 consecutive patients who underwent video-assisted thoracoscopic pleurectomy or pleural abrasion for spontaneous pneumothorax between April 2003 and August 2004. We assessed CRP levels in pleural and blood samples taken daily in the first 4 postoperative days. RESULTS: Intrapleural CRP profile was significantly lower in patients who underwent pleural abrasion, in younger patients (< 25 years) and in patients who were not drained before surgery. Patients with pleurodesis failure had a lower CRP peak with a delayed peak. Receiving operating characteristics (ROC) analysis showed that the cutoff value of intrapleural CRP for pleurodesis failure was 25 mg/l on the second postoperative day (sensitivity 87.5 %, specificity 66.6 %, positive predictive value 24.1, negative predictive value 97.7 %). CONCLUSIONS: Pleural CRP levels of less than 25 mg/l on the second postoperative day indicate only a moderate pleural inflammation.

Adolescent↗
PubMed2005

Mediastinal cystic lymphangioma: is resection always necessary?

Mediastinal cystic lymphangiomas are rare tumours. Usually asymptomatic, they can be complicated by a chylopericardium or/and chylothorax. We report a case of a left lesion infiltrating through the supra-aortic vessels complicated with a iatrogenic left chylothorax managed by bilateral video-assisted thoracoscopy at the same time. First, on the right, the chylous inflow was stopped by suturing the thoracic duct; then, on the left, a fenestration was done to confirm the diagnosis and treat the lesion while preserving the adjacent structures.

Biopsy, Needle↗
PubMed2004

[Surgical treatment of pulmonary metastases of colorectal cancer. Do the indications evolved?].

AIM OF THE STUDY: The aim of this study was to evaluate a single-institution experience in the surgical treatment of lung metastases from colorectal cancer. PATIENTS AND METHODS: During a 16 years period, 42 patients underwent lung metastasectomy at the University Hospital of Nice for a total of 57 surgical interventions. Data were retrospectively collected and analysed in term of prognostic factors and long-term survival. RESULTS: The mean age was 64.5 years and there were 26 males and 16 females. In 36 cases lung metastasis were metachronous and the disease-free mean interval was 28.7 months. Eighteen patients had bilateral disease. In ten patients hepatic metastasectomy was done before lung resection. Forty-seven operations were performed for the 1(st) episode of lung metastasis (1 bilobectomy, 21 lobectomy, 4 segmentectomy and 38 wedge resections). Mediastinal metastatic disease was present in six patients. No patient died and the postoperative morbidity was 6.25%. Six patients needed operation for recurrent disease. Two patients died after completion pneumonectomy. Overall five and ten-year survival were 29.5 respectively 26.2%. The log-rank test identified two significant prognostic factors: radicality of metastasectomy (P =0.0066) and a disease-free interval longer than two years (P= 0.0021). CONCLUSION: Our study suggests that local control of lung metastasis can improve survival only when a radical resection can be achieved. Selection criteria need to be improved in order to avoid unnecessary lung resection in patients with high risk of recurrences. The Pet-scan should probably have a certain interest in selecting these patients.

Aged↗
PubMed2004

Patent foramen ovale after lobectomy. A contraindication to completion pneumonectomy?

Patency of the foramen ovale (FO) is a very rare complication after lobectomy. Completion pneumonectomy after FO reopening has never been described before. In the reported case, a patent FO was diagnosed in a 52-year old man 9 months after a left upper sleeve lobectomy for a squamous cell carcinoma pT2N1. At the same time, bronchoscopy showed an endobronchial recurrence in the left main bronchus. The foramen was closed percutaneously by a 35 mm Amplatzer prosthesis. Dyspnea improved dramatically in the following 4 weeks and no more oxygen therapy was required. After complete restaging, a completion pneumonectomy was performed without any postoperative complication. This case report suggests that pneumonectomy in such delicate patients is feasible.

Carcinoma, Squamous Cell↗
PubMed2003

Morgagni hernia and thoracic deformities.

We report two cases of Morgagni hernia associated with pectus carinatum. This association is exceptional; only two other cases have been reported so far. In one of our patients, an abdominal surgical approach was used to repair the Morgagni hernia and to perform a Nissen-Rossetti procedure (for an associated endobrachyesophagus); the patient did not require correction of the pectus carinatum. In the other patient, both thoracic deformity and Morgagni hernia were repaired using the same thoracic approach.

Adult↗
PubMed2001

Combined video-assisted mediastinoscopy and video-assisted thoracoscopy in the management of lung cancer.

BACKGROUND: This study seeks to assess the safety and usefulness of combined video-assisted mediastinoscopy and video-assisted thoracoscopy in the management of patients with lung cancer. METHODS: Ten consecutive patients with lung neoplasms were evaluated. Indications for this combined approach included inconclusive findings from imaging techniques concerning locoregional extension and resectability; possible involvement of different structures not accessible to a single procedure; and failure to obtain histologic diagnosis by a single technique. RESULTS; Histologic diagnosis was obtained in 6 patients without preoperative histologic typing. In 3 patients, in contrast with preoperative imaging studies, combined thoracoscopy and mediastinoscopy showed the resectability of the primary tumor and the absence of metastatic mediastinal lymph nodes. These findings were confirmed at thoracotomy. In 3 other patients prevascular lymph nodes metastases were found. They underwent neoadjuvant chemotherapy; at subsequent operation, a complete resection was possible. In the remaining four cases combined exploration proved definitive contraindications for operation (recognition of oat-cell carcinoma, n = 2; T4 status, n = 1; T3N2, n = 1). CONCLUSIONS: Combined video-assisted mediastinoscopy and video-assisted thoracoscopy seems to be a safe and useful tool in the management of selected patients with lung neoplasms. Both the extent of primary tumor and the possible intrathoracic spread may be exhaustively evaluated. In patients with left lung cancer a complete exploration of the aortopulmonary window is possible.

Aged↗
PubMed2001

Improvement of 'dynamic analgesia' does not decrease atelectasis after thoracotomy.

There is still controversy concerning the beneficial aspects of 'dynamic analgesia' (i.e. pain while coughing or moving) on the reduction of postoperative atelectasis. In this study, we tested the hypothesis that thoracic epidural analgesia (TEA) prevents these abnormalities as opposed to multimodal analgesia with i.v. patient controlled analgesia (i.v. PCA) after thoracotomy. Fifty-four patients undergoing thoracotomy (lung cancer) were randomly assigned to one of the two groups. Clinical respiratory characteristics, arterial blood gas, and pulmonary function tests (forced vital capacity and forced expiratory volume in 1 s) were obtained before surgery and on the next 3 postoperative days. Atelectasis was compared between the two groups by performing computed tomography (CT) scan of the chest at day 3. Postoperative respiratory function and arterial blood gas values were reduced compared with preoperative values (mean (SD) FEV1 day 0: 1.1 (0.3) litre; 1.3 (0.4) litre) but there was no significant difference between groups at any time. PCA and TEA provided a good level of analgesia at rest (VAS day 0: 21 (15/100); 8 (9/100)), but TEA was more effective for analgesia during mobilization (VAS day 0: 52 (3/100); 25 (17/100)). CT scans revealed comparable amounts of atelectasis (expressed as a percentage of total lung volume) in the TEA (7.1 (2.8)%) and in the i.v. PCA group (6.71 (3.2)%). There was no statistical difference in the number of patients presenting with at least one atelectasis of various types (lamellar, plate, segmental, lobar).

Aged↗
PubMed2000

Recurrent pneumothorax associated with thoracic endometriosis.

Herein we report the cause of a 46-year-old woman who presented with recurrent right pneumothorax following hysterectomy with right salpingo-oophorectomy for pelvic endometriosis. Video-assisted thoracoscopy revealed endometrial implants in the posterior parietal pleura and the middle lobe. Ruptured apical blebs were also present. The middle lobe lesions and the apical blebs were resected. A partial pleurectomy was carried out to remove the endometrial foci in the parietal pleura; the remaining pleural surface was mechanically abraded. The favorable outcome was confirmed at 2-year follow-up.

Endometriosis↗
PubMed2000

Intrathoracic migration of Kirschner pins.

We report two cases of intrathoracic migration of Kirschner pins used for the treatment of sternoclavicular joint dislocation. The migration was asymptomatic in both cases. Treatment involved median sternotomy in one patient and video-assisted thoracoscopy in the other. A favorable outcome was observed in both patients. The reports confirm the potential dangers related to management of sternoclavicular joint dislocation with metallic fixation devices.

Adult↗
PubMed2000

Lemierre's syndrome with bilateral empyema thoracis.

A 31-year-old patient is described with thrombophlebitis of the right jugular vein, and anerobic septicemia (Lemierre's syndrome). Multiple pulmonary abscesses and bilateral fibrinopurulent empyema were also present. Treatment included intravenous antibiotics, heparin, and video-assisted thoracoscopic debridement of pleural cavities. A favorable outcome was observed.

Adult↗
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

Video-mediastinoscopy in management of patients with lung cancer: a preliminary study.

Cervical mediastinoscopy is widely employed for biopsy of mediastinal lymph nodes and staging of lung cancer. The application of video-assisted technology to mediastinoscopy in a series of patients with lung cancer has not been reported. Preliminary experience with the use of video-mediastinoscopy in diagnosis and staging of lung cancer is presented. Fifteen patients with lung cancer were studied. Results of previous computed tomography scans had shown the presence of enlarged mediastinal lymph nodes in the retrovascular plane in all of the cases. Video-mediastinoscopy was performed under general anesthesia using a specifically designed rigid scope connected to a mono-charged-coupled device video camera (model INH 002756; Karl Storz-Endoskope, Tuttlingen, Germany). Neither fatalities nor major complications related to the procedure were observed. In all cases, video-mediastinoscopy proved useful for diagnosis or staging of lung cancer, therefore contributing to clinical decision making. The optimal visualization of mediastinal structure and the possibility for the surgeon to operate with both hands are appreciable characteristics of this technique.

Adenocarcinoma↗
PubMed1999

[Adenocarcinoma in Barrett's esophagus. A study of 28 resected cases].

STUDY AIM: The aim of this retrospective study was to report a series of 28 patients with adenocarcinoma (ADK) arising in Barrett's esophagus (BE), treated by esophagectomy. PATIENTS AND METHODS: From 1992 to 1998, 28 patients were operated on for ADK in BE. There were 27 men and one woman (mean age: 65 years) classified as ASA I (n = 2), ASA II (n = 15) and ASA III (n = 11). Eighteen patients had a long story of gastro-esophageal reflux disease which required surgical repair in five of them. Dysphagia was the main symptom (n = 19). Surgical procedures included 15 Ivor Lewis operations, nine esophagectomies without thoracotomy and four esophagogastrectomies by the left thoracic approach. RESULTS: Pathological examination of the specimens showed an EBO with adenocarcinoma (n = 27) and a high grade dysplasia (n = 1). Among five patients with a previously known BE, three under endoscopic surveillance had high grade dysplasia (n = 1) and limited T1 tumor (n = 2), while the other two patients without surveillance developed an invasive tumor (T3N1). There were three postoperative deaths (mortality rate: 10%), all arising from pulmonary failure. Median survival was 16.6 months. All patients resumed a normal diet. The actuarial survival rates were 63%, 42% and 15.2% respectively at 1, 2 and 4 years. A multivariate analysis could identify 3 prognostic factors: ASA score previously known BE under surveillance, length of BE. CONCLUSION: Adenocarcinoma arising in BE is very often diagnosed too late. Patients with high risk BE require an endoscopic survey. High grade dysplasia detected in two successive examinations by two different pathologists may require prophylactic esophagectomy, but local endoscopic management presently under evaluation could be efficient in the future.

Actuarial Analysis↗
PubMed1999

Nephrobronchial fistula secondary to xantogranulomatous pyelonephritis.

We report a case of staghorn nephrolithiasis that evolved into xanthogranulomatous pyelonephritis with perinephric abscess, nephrobronchial fistula, and lung abscess. The patient was an intravenous drug abuser who tested positive for human immunodeficiency virus, without evidence of acquired immunodeficiency syndrome. He presented with a 2-month history of untreated repeated episodes of left flank pain and hyperpyrexia. Treatment involved left nephrectomy, debridement of abscess, tube drainage, and intravenous antibiotics. The patient illustrates the need to consider untreated nephrolitiasis as a predisposing factor for pulmonary complications.

AIDS-Related Opportunistic Infections↗