PubMed Health⌕ Search

Biomedical subjects

L Garbe

Publications and source records attributed to L Garbe.

At least 19 recordsLinked to original sources
PubMed2001

Exsanguinating hemoptysis revealing the absence of left pulmonary artery in an adult.

Isolated absence of a pulmonary artery is an exceptional cause of massive hemoptysis. We report a 35-year-old woman with agenesis of the left pulmonary artery who presented with exsanguinating hemoptysis that prompted angiography with the aim to embolize the bleeding vessels selectively. The procedure could not be completed because of the presence of an anterior spinal artery branching from the aberrant systemic-to-pulmonary circulation. The patient successfully underwent an emergent pneumonectomy.

Adult↗
PubMed2000

Osteosarcomas of flat bones in adolescents and adults.

BACKGROUND: Osteosarcomas typically are long bone tumors and rarely affect the flat bones of the axial or appendicular skeleton. METHODS: The authors examined cases of high grade osteosarcoma of flat bones diagnosed at La Timone Adults University Hospital during a 16-year period. RESULTS: Sixteen patients with flat bone osteosarcomas were treated between 1980-1997. The median age of the patients was 25 years, with a male-to-female ratio of 14:2. Common presenting symptoms were swelling, pain, or both. Primary therapy included resection (n = 11 patients: alone in 8 patients and with radiation therapy in 3 patients), radiation therapy (n = 2 patients), or no local treatment (n = 3 patients). All patients received polychemotherapy, 7 preoperatively and postoperatively and 9 in the adjuvant setting. The overall 5-year survival rate was 47.7%; the overall median survival was 39 months (range, 4-211 months). The adequate local control rate was 68.7%. The local recurrence rate in patients who benefited from local treatment was 54%. Significant adverse prognostic factors on survival included the presence of synchronous metastases (three patients), metastases at any time during the course of the disease (eight patients), and inadequate local control (five patients). The overriding predictor of survival appeared to be the presence of metastases. Local recurrence appeared to have no influence on survival. No patient with metastases was alive at 3 years, whereas patients without recurrence or with local recurrence alone had a 5-year survival rate of 100%. Because the majority of patients with flat bone osteosarcomas ultimately die of metastatic disease, intensive systematic polychemotherapy should be an important component of treating these tumors. CONCLUSIONS: Based on the very encouraging results observed in the treatment of long bone osteosarcomas, the therapy for flat bone osteosarcomas should combine radical surgery with preoperative and postoperative adjuvant chemotherapy.

Adolescent↗
PubMed2000

Diagnostic accuracy of protected catheter sampling in ventilator-associated bacterial pneumonia.

The aim of this study was to assess the accuracy of protected telescoping catheter performed using: 1) protected distal aspiration, or 2) protected mini-bronchoalveolar lavage for the diagnosis of ventilator-associated bacterial pneumonia. Twenty-seven patients who died after receiving mechanical ventilation for at least 72 h were included in a comparative prospective post-mortem study. The two microbiological sampling procedures were performed immediately after death. Surgical pneumonectomies and biopsies were performed within 30 min of death at the bedside for histological examination. The results of the two techniques were compared with histological post-mortem lung examination or biopsies. Histological examination of the parenchyma showed signs of pneumonia in 14 cases. Lung tissue culture was positive in nine of these 14 cases. When ventilator-associated bacterial pneumonia was defined by the association of histological signs and positive lung tissue culture the sensitivity was 78% for both sampling techniques, specificity was 86% for mini-bronchoalveolar lavage and 100% for protected distal aspiration (at a threshold of 1 x 10(3) cfu x mL(-1)). Both techniques protected the distal aspiration and mini-bronchoalveolar lavage, and provided good specificity with an acceptable sensitivity for the diagnosis of ventilator-associated bacterial pneumonia.

Aged↗
PubMed2000

[Bronchial mucoepidermoid carcinoma: apropos of 3 cases].

We report three cases of bronchial mucoepidermoid carcinoma (BMEC) of low-grade malignancy with a relafase-free follow up. BMEC are rare tumors. The microscopic findings distinguish low-grade tumors which occur in children and young adults and high-grade tumors concerning older patients; this grading is based on the study of the epidermoid component. If possible, conservative therapy is appropriate in low-grade tumors. The prognosis of high-grade tumors is poor.

Adult↗
PubMed1999

Aggressive form of pleural epithelioid haemangioendothelioma: complete response after chemotherapy.

Epithelioid haemangioendotheliomas are rare tumours of endothelial origin. They can develop in any tissue but occur principally in the lung and liver. Their usual course is a slow progression, so that they can be treated by surgery. In aggressive forms, no treatment has proved efficient to date. This study, describes a case of bilateral pleural epithelioid haemangioendothelioma that extended to the peritoneum. The histological diagnosis was confirmed by both conventional examination and immunohistochemistry. After six courses of carboplatine plus etoposide, a complete response was obtained. The complete remission is still lasting at 18 months after the diagnosis and the patient is healthy.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1999

Pulmonary arteriovenous malformations: lung transplantation as a therapeutic option.

Multiple pulmonary arteriovenous malformations (PAVM) constitute an uncommon cause of respiratory disability. They may lead to severe hypoxaemia via right-to-left shunts and are sources of substantial mortality and morbidity. Conservative surgical resection has been proposed as the treatment of choice. More recently, percutaneous balloon or coil embolization of the feeding vessels offered an efficacious and safe alternative therapy for patients whose fistulas are too numerous to excise. This study reports an unusual case of respiratory disability in a patient with multiple and microscopic pulmonary arteriovenous malformations who failed to respond to embolotherapy and who received a double lung transplantation with good initial outcome.

Adult↗
PubMed1999

[Mucoepidermoid bronchial tumor with an unusual radiologic presentation].

We report a case of low-grade malignant mucoepidermoid bronchial tumor in a 21-year-old woman who presented with hemoptysis. There was a striking radiological presentation with a unilateral clear radiograph. Lung scintigraphy demonstrated perturbed ventilation and perfusion of the left lung. Pulmonary angiography only showed diminished peripheral vascularization. The main vessels were clear. These anomalies fit the radiological category of air trapping accompanied by probably hypoxic pulmonary vasoconstriction. Mucoepidermoid tumors account for only 0.5-1% of all primary lung tumors. They are found in adults as well as in children. There are two clear-cut histological forms with very different prognosis. The tumors of high-grade malignancy are considered as undifferentiated carcinomas and should be treated as such. The prognosis is much better for tumors of low-grade malignancy and current treatment is surgical in the absence of recurrence after isolated endoscopic treatment.

Adult↗
PubMed1998

Open-lung biopsy in patients with acute respiratory distress syndrome.

BACKGROUND: It has been suggested that fibrosis present during the fibroproliferative phase of acute respiratory distress syndrome (ARDS) can be treated by corticosteroids. However, neither clinical nor microbiologic criteria permit differentiation of this fibroproliferative phase from a nosocomial pneumonia. The aim of this observational case series was to evaluate the safety and utility of open-lung biopsy (OLB) performed in patients receiving ventilatory support who had persistent ARDS despite negative bacterial cultures. METHODS: During a 4-yr period, 37 OLBs were performed in 36 of 197 patients receiving ventilatory support who had ARDS. The severity of ARDS was assessed by a lung injury score of 3.1 +/- 0.4 (mean +/- SD) and a median ratio of the partial pressure of oxygen (PaO2) to the fraction of inspired oxygen (FiO2) of 118 mmHg. Histologic examination; bacterial, fungal, and acid-fast staining; and cultures of the tissue sample were performed. RESULTS: Fibrosis was present in only 41% of the lung specimens obtained by OLB. Only six patients received corticosteroids (17%). In 9 of the 15 patients with fibrosis, cytomegalovirus pneumonia precluded the use of corticosteroids. Histologic cytomegalovirus pneumonia was diagnosed in 18 cases. Histologic bacterial or mycobacterial pneumonia was diagnosed in five cases. No significant change in arterial blood gases was noted as linked to the biopsy procedure except an increase of the PaO2/FiO2 ratio. One pneumothorax was diagnosed on a chest roentgenogram 12 h after OLB. Only one patient required blood transfusion during the 48-h period after OLB (for an hemothorax). Five patients had moderate air leaks from operative chest tubes for 2-10 days. CONCLUSIONS: Open lung biopsy appeared to be a useful and acceptably safe diagnostic technique in patients with ARDS. It permitted the diagnosis of unexpected cytomegalovirus pneumonia.

APACHE↗
PubMed1998

[Ecoendoscopy in the assessment of esophageal neoplasms].

OBJECTIVE: To asses the diagnostic accuracy of endoscopic ultrasonography (EUS) for the local and regional staging of esophageal cancer, and its possible alteration resulting from the performance of preoperative chemoradiation. METHODS: Prospective study of 85 consecutive patients with esophageal cancer evaluated by EUS and operated between January 1992 and December 1995. 28 of these patients had received previous induction therapy. In all cases, EUS examination was performed by the same physician not informed about the results of previous morphological explorations. Histopathological analysis of all specimens was performed by the same pathologist, not informed about the results of the EUS. Data were collected by another independent observer. RESULTS: EUS examination resulted in incomplete staging in 8 patients (9.5%) with severe stenosis precluding endoscope passage. The accuracy, specificity and sensibility of EUS in detecting the depth of esophageal involvement (T0-2 vs T3-4) were 82.3%, 78% and 86% respectively, and 72%, 70% and 73% respectively for the lymph node metastasis. The overall accuracy of EUS in identifying the preoperative stage was 67% with a clear-cut alteration when patients had received induction therapy (61% vs 72%). On the other hand, 7(64%) of the 11 patients thought to have a complete response at endosonography had no residual tumor. CONCLUSION: EUS provides precise information for the preoperative identification of locally advanced esophageal tumor, even after induction therapy. The latter alters the diagnostic accuracy of EUS, although complete responders could be identified in two-thirds os cases.

Adult↗
PubMed1997

Diagnosis of ventilator-associated pneumonia: an evaluation of direct examination and presence of intracellular organisms.

BACKGROUND: Ventilator-associated pneumonia (VAP) requires early diagnosis and adequate antibiotic therapy. The aim of this prospective postmortem study was to assess the accuracy of direct examination and quantification of intracellular organisms (ICO) for the diagnosis of VAP. METHODS: Total and differential cell counts were performed on fluids recovered using nonbronchoscopic sampling techniques (blind bronchial sampling [BBS], mini-bronchoalveolar lavage [mini-BAL]) and from bronchoalveolar lavage (BAL) performed during fiberscopy. These 3 sampling techniques were done within 15 min of death without discontinuing mechanical ventilation. Quantification of ICO was performed on each sample recovered from the various sampling procedures. Gram reaction and morphology of bacteria were evaluated on Gram smears. RESULTS: The results of each technique were compared with histology and culture of lung tissue specimens obtained by surgical pneumonectomies in 28 patients who died after at least 72 h of mechanical ventilation. Histology was positive in 13 patients and negative in 15 patients. When only VAP with positive lung culture was considered (histologic signs of bronchopneumonia plus positive lung tissue culture), the sensitivity of Gram staining on BAL, mini-BAL, and BBS was 56%, 44%, and 56%, respectively. If all samples were considered, the sensitivity and the specificity of the determination of the percentage of ICO were low (less than 70%) whatever the sampling technique. CONCLUSIONS: For initial therapeutic guidance, direct examination and presence of ICO do not contribute for establishing the diagnosis of VAP, essentially because of a lack of sensitivity. However, when positive, Gram staining can obviously guide initial antibiotherapy.

Aged↗
PubMed1997

[Endosonography in the preoperative evaluation of cancers of the esophagus].

OBJECTIVE: To assess the diagnostic accuracy of endoscopic ultrasonography (EUS) for the local and regional staging of esophageal cancer, and its possible alteration resulting from the performance of preoperative chemoradiation. METHODS: Prospective study of 85 consecutive patients with esophageal cancer evaluated by EUS and operated on between January 1992 and December 1995. 28 of these patients had received previous induction therapy. In all cases, EUS examination was performed by the same physician not informed about the results of previous morphological explorations. Histopathological analysis of all operative specimens was performed by the same pathologist, not informed about the results of EUS. Data were collected by another independent observer. RESULTS: EUS examination resulted in incomplete staging in 8 patients (9.5%) with severe stenosis precluding endoscope passage. The accuracy, specificity and sensitivity of EUS in detecting the depth of esophageal involvement (T0-2 vs. T3-4) were 82.3%, 78%, and 86% respectively, and 72%, 70%, and 73% respectively for lymph node metastasis. The overall accuracy of EUS in identifying the preoperative stage was 67%, with a clear-cut alteration when patients had received induction therapy (61% vs 72%). On the other hand, 7 (64%) of the 11 patients thought to have a complete response at endosonography had no residual tumor. CONCLUSION: EUS provides precise information for the preoperative identification of locally advanced esophageal tumor, even after induction therapy. The latter alters the diagnostic accuracy of EUS, although complete responders could be identified in two-thirds of cases.

Adult↗
PubMed1997

Changing patterns and surgical results in adenocarcinoma of the oesophagus.

BACKGROUND: Prognosis of oesophageal adenocarcinoma is notoriously dismal. To examine the changing patterns of and treatment strategies for this disease, the longitudinal experience of a single institution over 16 years is reported. METHODS: The study comprised a retrospective review of 551 consecutive patients operated on for oesophageal cancer between 1979 and 1995, of whom 164 had adenocarcinoma. There were 13 women and 151 men whose mean age was 61 (range 17-82) years. RESULTS: The prevalence of adenocarcinoma (P = 0.002), that of early tumours (P < or = 0.10), and the resectability rate (P < or = 0.05) increased throughout the period whereas operative mortality rate decreased (P < or = 0.10). Surgical approach changed without influence on long-term survival. Patients referred from endoscopic surveillance programmes for Barrett's oesophagus (n = 16) had an improved survival rate compared with that of non-surveyed patients (P < or = 0.01). Overall 5-year survival after oesophagectomy (17 per cent) improved for the period 1991-1995 when compared with 1979-1982 (P < or = 0.02). Univariate analysis identified tumour node metastasis (TNM) stage, number of diseased lymph nodes, invasion of the oesophageal stump and occurrence of a postoperative complication as significant prognostic variables (P < or = 0.05). Multivariate analysis demonstrated that T stage (P = 0.0002) was the main independent predictor. CONCLUSIONS: Recent improvement of results reflects patient selection, increased prevalence of early tumours, and dramatic reduction of the risks from oesophagectomy. New therapeutic directions should be investigated for locally advanced tumours.

Adenocarcinoma↗
PubMed1997

[Severe bronchial stenosis with upstream bronchiectasis in an arc welder: causal relation or epiphenomenon?].

This case concerns an arc welder who presented suppurative bronchiectasis and episodes of purulent left side pleurisy in relation to cystic bronchiectasis of the left lower lobe and a very severe stenosis at the origin of the main left bronchus. The medicolegal problem was to assess the causal relationship between these lesions and occupational exposure. They do not come under the heading of table 44 of the General List and we made this the aim of discretionary award in front of a regional committee of compensation for occupational disease.

Bronchial Diseases↗
PubMed1997

[Primary spinal osteosarcomas].

The rarity of primary osteosarcoma of the spine led us to index the 66 reported cases published in literature. From this analysis a difference was found between spinal osteosarcoma and osteosarcoma of the extremities. Tumors of the spine appear to be two times more frequent in the male population in their thirties. The average period between the beginning of the symptoms and the first consultation is seven months. Back pain is permanent and localized to the affected vertebra. In 80 percent of the cases, neurological symptoms already exist at the stage of the diagnosis. Magnetic resonance imaging (MRI), computed tomography and standard X-ray remain complementary in the morphological analysis of this tumor. All the aspects from the lytic to sclerotic forms are noted, although the lytic form is common. Among spinal osteosarcoma, the lumbar vertebrae are the most frequently affected. Diagnosis can only be established by pathology, even though this may also lead to some errors. In all the reported cases surgery is used, but carcinological methodology is not possible and a complete removal of affected tissue is difficult, with this being achieved in only a quarter of the cases. Radiation therapy, when used, requires doses of 70 Gy to 80 Gy without any certitude of controlling the tumour and with high risks of post-radiation complications. Chemotherapy on its own, despite the use of high-dose methotrexate, only has a temporary effect due to partial action on the primary center. Twenty years ago, only twenty percent of all patients suffering from osteosarcoma lived beyond two years, with worse prognosis for spinal osteogenic sarcoma. Today, the therapeutic approach for spinal tumors uses techniques developed in the treatment of osteosarcoma of the extremities, which can now expect more than seventy percent of all patients to live beyond five years. Present day methods recommend a rapid confirmation of the diagnosis, and then a neoadjuvant chemotherapy followed by surgery to remove all the affected area. This strategy allows an evaluation of the tumor chemosensitivity and to adapt the treatment in consequence. The latest results of this treatment on spinal osteosarcoma appear to be encouraging.

Humans↗
PubMed1997

[Primary spinal osteosarcoma. Apropos of a case].

We report a case of primary osteogenic sarcoma of the third lumbar vertebra, detailing the neuroradiologic and therapeutic aspects. The clinical presentation was limited to low back pain which radiated to the left thigh for 5 months. Lumbosacral spine roentgenograms revealed a sclerotic lesion of the left part of the body of the third lumbar vertebra. Treatment consisted of total vertebrectomy, chemotherapy completed with radiotherapy. Fourteen months after a complex combined treatment no recurrence was observed. A review of the literature highlighted the rarity of this tumor. Usually, patients with vertebral osteogenic sarcoma do poorly. Today, the therapeutic approach for these spinal tumors should use techniques developed in the treatment of osteosarcoma of the extremities because of their encouraging results.

Adult↗
PubMed1997

[Induction treatment of locally advanced operable cancers of the esophagus. Prognostic significance of the histologic response].

OBJECTIVE: The purpose of this study was to determine the prognostic significance of the histopathological response to preoperative radio-chemotherapy in patients with locally advanced oesophageal cancer. METHODS: Among the 57 patients included in this open prospective study, the disease-free survival of 48 patients (8 females 40 males; mean age: 56.6 years +/- 8.4) who underwent an oesophagectomy after induction therapy for oesophageal squamous cell (n = 38) or adenocarcinoma (n = 10) was correlated with the histopathological findings. Chemoradiation included 2 cycles associating continuous 5 FU from D1 to 5 and from D22 to 26, cisplatyl on D1 and D22, 15 Gy/5d from D1 to 5 and from D22 to 26. Histopathological response was assessed on the operative specimens by routine examination of serial thin sections each 5 mm along the full oesophageal length, the resection margins and the lymph node dissection. RESULTS: A wide interindividual variability was seen regarding tissue changes related to induction therapy, with a grading in tumor regression and the possibility of dissociated effects on the various treatment targets: tumor, adenopathy and vessel invasion. The 5-year probability of disease-free survival was 22% for the 48 resected patients. The presence of a complete histopathological response (n = 12) did not preclude metastatic spread in half the cases. Furthermore, it did not result in improved survival when compared to that of non-responder patients. Survival of patients who had a complete or major oesophageal response (n = 29, 35% at 5 years) was significantly lower than that of patients who were operated on during the same period for a superficial oesophageal cancer at presentation (n = 29, 57% at 5 years; P = 0.03). After multivariate analysis according to the Cox model, downstaging of the primary tumor was not identified as an independent predictor of disease-free survival. CONCLUSIONS: Pathologic assessment of tumor regression on the operative specimen provides little prognostic information.

Adenocarcinoma↗