Biomedical subjects

L F Jacques

Publications and source records attributed to L F Jacques.

5 recordsLinked to original sources

PubMed1998

Clinical patterns and trends of outcome of elderly patients with bronchogenic carcinoma.

OBJECTIVE: To investigate the clinical characteristics and determinants of operative mortality and long-term survival of elderly patients submitted to pulmonary resection for intended cure of lung cancer. METHODS: Retrospective analysis of 500 consecutive pulmonary resections performed in patients aged over 70 years from 1975 to 1996. Predictors of in-hospital mortality were identified by univariate and multivariate analyses. Determinants of long-term outcome were investigated in all survivors, with no patient being lost to follow-up. RESULTS: Mean age was 74 +/- 3 years (maximum: 90), and 36 patients were octogenarians. The sex-ratio M:F was 5:3. History of combined cardiovascular or previous neoplastic disease was noted in 193 and 63 patients, respectively. The predominant histology was squamous cell carcinoma (n = 243), with a significantly higher incidence in male than in female. Most patients received standard procedures, while 103 patients underwent extended resections for tumors involving the mediastinum (n = 44), the chest wall (n = 33), the carina (n = 2) or had a sleeve resection of the main bronchus (n = 24). Procedures were considered to be complete and curative in 459 patients, among whom 294 had a stage I disease. There were 37 (7.4%) in-hospital deaths. Mortality rates following pneumonectomy, bilobectomy, lobectomy and lesser resection were 11:136, 4:34, 22:291, and 0:39, respectively. Age, male gender, hypertension, low FEV1 and extended procedure were identified as independent predictors of early mortality. Overall survival rates were 33.7 and 12% at 5 and 10 years, respectively. Multivariate analysis demonstrated that the disease stage was the main prognosticator. During the follow-up period, cancer recurrence (n = 183; 39.5%) or second primary lung cancer (n = 20; 4.3%) occurred in 203 patients, among whom 18 (9%) had a second lung resection. Carcinoma in other systems occurred in 25 patients (5.3%), and major cardiovascular event in 51 (11%). CONCLUSIONS: Male and squamous cell carcinoma are characteristic of elderly patients with resected lung cancer. Operative mortality is acceptable for standard resection, and survival figures are concordant with those reported in other series which include younger patients.

Aged↗

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

Videothoracoscopic operations for bullous lung disease.

Recurrent primary spontaneous pneumothoraces can be treated easily by videothoracoscopic techniques. Although long-term follow-up is still lacking, VATS apical blebectomy and apical pleurectomy give excellent short-term results with recurrence rates below 1%. Because the technique is less invasive than open thoracotomy, it is also advantageous for the treatment of patients with pneumothoraces secondary to emphysema. Thoracoscopic treatment of diffuse emphysema remains investigational.

Endoscopy↗

PubMed1991

The risk of lymph node metastasis in colorectal polyps with invasive adenocarcinoma.

One hundred fifty-one patients with colorectal polyps containing invasive adenocarcinoma treated by resection were studied to determine the incidence of lymph node metastasis and whether lymph node metastasis was related to the depth of invasion. Other variables evaluated included size and configuration of the polyp, grade of adenocarcinoma, presence or absence of lymphovascular invasion, and degree of differentiation. In patients with sessile polyps, the incidence of lymph node metastasis was 10 percent. Eighty percent of these lesions had lymphovascular invasion. For pedunculated polyps, the overall incidence of lymph node metastasis was 6 percent. However, there was no incidence of lymph node metastasis when the depth of invasion was limited to the head, neck, and stalk of the polyp (Levels 1, 2, and 3). Only when the depth of invasion reached to the base of the stalk (Level 4) was the risk of lymph node metastasis high (27 percent). The other risk factors were not associated with lymph node metastasis. We concluded that the most significant risk factor for lymph node metastasis in patients with invasive carcinoma in a polyp was invasion into the submucosa of the bowel wall (Level 4).

Adenocarcinoma↗

PubMed1988

Successful repair of an unusual hernia associated with traumatic pubic diastasis.

A 70-year-old man had an unusual type of supravesical small bowel hernia associated with herniation of the bladder through a traumatic diastasis of the pubic symphysis. The diastasis was closed with prosthetic mesh through a preperitoneal approach. In patients in whom a scrotal hernia develops after a previous pelvic fracture, especially those with evidence of a pubic diastasis, an unusual type of hernia should be suspected. A preperitoneal surgical approach best reveals the anatomy and allows appropriate repair. The best procedure for prevention of such hernias is primary reduction of any substantial pubic diastasis, but operative intervention is not indicated in all patients.

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