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Biomedical subjects

L Guibert

Publications and source records attributed to L Guibert.

At least 19 recordsLinked to original sources
PubMed1999

Prognostic factors and results after surgical treatment of primary sarcomas of the lung.

BACKGROUND: Primary sarcoma of the lung is a rare tumor. Our purpose was to study survival after resection and prognostic factors, which have been rarely reported. METHODS: In a 24-year period, we performed 20 complete resections and three exploratory thoracotomies only for primary lung sarcomas. One patient declined operation. Mean diameter of resected tumors was 9 cm (range, 4 to 18 cm). There were eight stage IB, eight stage IIB, one stage IIIA, and three stage IIIB. Sixty percent of patients with resected tumors received adjuvant therapy. Age, sex, resectability, tumor size, histologic cell type, stage, and adjuvant therapy were analyzed as predictors of survival. RESULTS: No postoperative deaths occurred. All 4 patients who had no resection died within 15 months. The 5- and 10-year actuarial survival after complete resection was 48%. The 5- and 10-year actuarial survival in stage IB was 83%, whereas the 4-year actuarial survival in stage IIB was 30% (p < 0.05). Complete resection and stage of disease were the sole significant prognostic factors. CONCLUSIONS: Complete resection of primary sarcoma of the lung, when feasible, can achieve prolonged survival, although almost half of the patients died of metastasis within 2 years of operation. Adjuvant therapy needs to be investigated.

Adolescent↗
PubMed1999

Survival and prognostic factors in patients undergoing parenchymal saving bronchoplastic operation for primary lung cancer: a series of 110 consecutive cases.

OBJECTIVE: The purpose of this study was to report our experience concerning bronchial sleeve lobectomy for treating bronchogenic cancer. METHOD: From 1980 to 1994, 110 patients underwent bronchial sleeve lobectomy for bronchogenic cancer. In 45 patients, preoperative investigations contraindicated pneumonectomy, whereas in 65 other patients, sleeve resection was performed without functional necessity. The most common procedures were sleeve lobectomy of the right upper lobe (64%), and of the left upper lobe (21%). Sixteen patients (15%) underwent additional arterial vascular resection. Seven patients had microscopic invasion of the bronchial margin without the possibility of further resection in six with regard to their limited respiratory function. Tumors were staged as follow: 32 stage IB (all T2 N0), 57 stage IIB (57T2 N1), and 17 stage IIIA (eight, T3N1; nine, T2N2), whereas four patients had an in situ cancer (four stage 0). RESULTS: Operative mortality was 2.75%. The 5- and 10-year actuarial survival rates were, respectively, 39 and 22% for the entire group. The 5-year actuarial survival rates were, 60% in stage IB, 30% in stage IIB, and 27% in stage IIIA. Four factors significantly influenced survival (P<0.05): nodal stage, arterial resection, invasion of the bronchial stump and poor functional respiratory status contraindicating pneumonectomy. CONCLUSIONS: In our experience, sleeve resection for stage I provides comparable survival to that of standard resection at equal stage. However, in patients with pathologically N1 disease, who can tolerate a pneumonectomy, a randomized study is mandatory to confirm that sleeve lobectomy can be performed without the risk of decreasing long-term survival. In our study, patients who required an associated vascular resection demonstrated a poor survival.

Adult↗
PubMed1998

[Videolaparoscopic treatment of paraesophageal hiatal hernia].

STUDY AIM: The aim of this prospective study was to report the results of videolaparoscopic repair in a series of ten patients with paraesophageal hernia. PATIENTS AND METHODS: From January 1982 to September 1998, ten patients (three men and seven women, mean age: 68 years [range: 42-87]) were operated on for paraesophageal hernia. An intrathoracic gastric volvulus was present in four patients, a severe anemia in four and two were asymptomatic. All interventions were performed laparoscopically and included sac resection, crura closure and realization of a posterior gastric valve on 270 degrees. RESULTS: There was one irruption of gastric juice in the bronchial tree at the beginning of the anesthesia which required assisted ventilation for 3 days. The mean follow-up was 17.5 months (range: 3-50). There was no postoperative diarrhea and no gas bloat syndrome. Eight patients complained of postoperative dysphagia which disappeared within 6 weeks, except in one patient with esophageal motility disorder postoperatively discovered. None of the patients had postoperative gastroesophageal reflux. A chest X-ray performed after 1 year detected no hernia recurrence in seven patients. There was no recurrent anemia after 6 months. CONCLUSION: The videolaparoscopic repair of paraesophageal hernias is feasible without any technical difficulties even in aged patients with precarious physical conditions. The results are good with a mean follow-up of 17.5 months.

Adult↗
PubMed1997

Results of re-resection for recurrent thymomas.

BACKGROUND: The treatment of recurrent thymomas remains controversial. PATIENTS: The place for re-resection was retrospectively studied in 28 consecutive patients operated on during the last 40 years. The initial Masaoka staging of the thymoma was stage I, 4; stage II, 8; stage III, 11; and stage IVa, 3. Postoperatively, 14 have had radiation therapy, 1 chemotherapy, and 13 no adjuvant treatment. Seven patients had development of recurrences, 15 had pleuropulmonary metastases, 5 had both, and 1 had thoracotomy scar recurrence. Nineteen patients had a complete resection and 9 an incomplete one. RESULTS: Most local recurrences appeared after resection of stage I or II thymomas. On the other hand, in patients with stage III or IV thymomas pleural or pulmonary metastases mainly developed. No local recurrence occurred in patients who initially received postoperative radiation therapy. Five-year and 10-year survival rates were 51% and 43%, respectively, for the overall population. Among the 19 patients with complete resection, only 3 patients had a subsequent recurrence; 1 of them could be reoperated on and is still alive and free of disease. CONCLUSIONS: Thymoma recurrences often appear as a locoregional rather than a hematogenous spread. Reresection can be recommended in selected patients.

Adult↗
PubMed1996

Long-term seton drainage for high anal fistulas in Crohn's disease--a sphincter-saving operation?

METHODS: Forty-one consecutive patients with Crohn's disease who underwent long-term seton drainage for high transsphincteric, suprasphincteric, or extrasphincteric anal fistula from 1985 to 1993 were reviewed. The subsequent associated procedure was simple seton removal (18), secondary fistulotomy (7), rectal flap advancement (3), and proctectomy (2). Eleven patients still had the seton in place. RESULTS: Recurrence developed in seven patients (39 percent) undergoing simple seton removal and in one patient undergoing rectal flap advancement. None of the patients treated by secondary fistulotomy developed a recurrence. At the end of follow-up, five patients (12 percent) required proctectomy mainly for severe proctitis, and five patients (12 percent) developed anal incontinence, which was severe in two. CONCLUSION: Long-term seton drainage for high and fistula in Crohn's disease is efficacious in both treating sepsis and preserving anal sphincter function.

Adolescent↗
PubMed1996

Immediate and long-term results after surgical treatment of primary spontaneous pneumothorax by VATS.

BACKGROUND: Video-assisted thoracic surgery has recently evolved as a viable alternative to thoracotomy for spontaneous pneumothorax. METHODS: A series of 163 patients with primary spontaneous pneumothorax were treated by video-assisted thoracic surgery. Seventy patients were treated for a recurrent episode, 64 patients for a persistent primary spontaneous pneumothorax, 24 patients for a contralateral episode, and 5 patients for a bilateral primary spontaneous pneumothorax. Stapling of bullae with an Endo-GIA stapler (Auto-Suture, Elencourt, France) was performed in 90% of the cases and parietal pleural abrasion was performed in each case. RESULTS: One revisional lateral limited thoracotomy was required for bleeding. Six patients had a prolonged air leak; 2 of them were reoperated on by lateral limited thoracotomy. Two patients have had an incomplete reexpansion of the lung and required a reoperation. The duration of hospitalization was 6.9 +/- 3 days. With a mean follow-up of 24.5 months, three recurrences requiring a reoperation occurred; 3 other patients had a partial recurrence and healed by rest without drainage. The mean time to return to the occupational activity of the patients was 42 +/- 34 days. These results were compared with those of a previous series of 87 patients operated on by lateral limited thoracotomy. CONCLUSIONS: With the development of surgical technique and video equipment, video-assisted thoracic surgery will probably become the treatment of choice of primary spontaneous pneumothorax.

Absenteeism↗
PubMed1995

Laparoscopic pericystectomy of a liver hydatid cyst.

The case of a patient with a liver hydatid cyst in the sixth hepatic segment is reported. Its favorable localization and its calcified state incited us to treat it by laparoscopy. The employed technique is discussed.

Echinococcosis↗
PubMed1995

[Celioscopic treatment of cholelithiasis in benign acute biliary pancreatitis].

OBJECTIVES AND METHODS: To evaluate the laparoscopic treatment of cholelithiasis in mild acute gallstone pancreatitis, 35 patients with gallstone pancreatitis and less than 4 Ranson's prognostic signs at 48 h were retrospectively included. RESULTS: Eight patients underwent preoperative endoscopic retrograde cholangiopancreatography. Surgery was performed a median of 15 (range: 4-60) days after the onset of pancreatitis, and included laparoscopic cholecystectomy with intraoperative cholangiography that was successful in 30 out of 32 cases (93%). A common bile duct stone was present in 4 patients (11%). Conversion to open surgery was necessary in 3 patients (8%). Choledocholithiasis was successfully removed by laparoscopy in two cases, and by laparotomy and postoperative endoscopic sphincterotomy in one case each. CONCLUSION: Laparoscopic treatment can be recommended as the primary treatment within a few days after the onset of mild gallstone pancreatitis.

Acute Disease↗
PubMed1987

[A case of exostosis of the base of the acetabulum in a child with multiple exostoses].

The authors report a case of an exostosis of the base of the acetabulum seen at the age of four months in a routine radiograph of the pelvis in a child suffering from osteochondromatosis. The growth in size of this exostosis led to subluxation of the hip at the age of three years. Surgical removal resulted in reduction of the subluxation and restoration of joint stability three years after operation. An intra-acetabular site for an exostosis has rarely been described.

Acetabulum↗
PubMed1986

[Ectopic insertions of single ureters in children. Apropos of 9 cases].

The authors present 9 cases of ectopic implantation of a single ureter in children. Ureteric ectopia is part of a congenital anomaly of the whole of the urinary tract, which explains the incidence of renal ectopia and associated dysplastic lesions of the renal parenchyma. The authors stress the importance of ultrasonography and, more recently, the CT scan for the localisation of the kidney homolateral to the ureteral ectopia. An analysis of the treatment and the results demonstrates the contrast between the unilateral forms which are easily treated and which have a good prognosis and the bilateral forms which are more difficult to treat and have a less favourable prognosis.

Abnormalities, Multiple↗
PubMed1986

[Prenatal diagnosis of ovarian cysts].

The authors report 10 cases of ante-natally diagnosed ovarian cysts. Ultrasonography greatly contributed to the diagnosis of this condition rarely described before. These cysts are usually follicular cysts. Physiopathological explanation still remain unclear: excessive fetal gonadotrope activity, enzymatic abnormality of the theca interna, abnormal stimulation by the mother's HCG are the main hypothesis. Ultrasonographic prenatal diagnosis is based on the discovery of an intra-abdominal round liquid area in a female fetus with normal kidneys and bladder. Obstetrical management is very simple: observation and vaginal delivery. After birth, diagnosis is assessed by clinical examination and ultrasonography which may be able to recognize a possible torsion (intracystic fluid septation). Treatment is conditioned by two facts: first these cysts are usually follicular benign lesions, second there is a high risk of complications, mainly torsion or rupture. Non-operative treatment and observation can be justified for very small cysts which have low risk of torsion. Laparotomy confirms the diagnosis: regarding non complicated cysts, surgery must be as conservative as possible: cystectomy is often feasible, leaving a laminated but functional ovary. Percutaneous puncture under ultrasonography could be considered.

Female↗
PubMed1986

[Post-traumatic algodystrophy in children].

The authors report two cases of Reflex Sympathetic Dystrophy (RSD) significant by their releasing factor: initial trauma followed by surgical act. They describe the particularities of RSD in children compared with RSD in adult: differents localizations, X Ray films often normals or showing a local homogeneous osteoporosis, bone scintigraphy with variable result (increased or normal or less uptake of isotope), more rapidly favorable evolution.

Carpal Bones↗
PubMed1985

[Primary perirenal suppurations in children: surgical or percutaneous drainage?].

Renal and perirenal staphylococcal suppurative processes are rare since antibiotic era. Three cases are reported. Gram negative organisms are nowadays the most prevalent bacterial species: a urinary tract disease must then be suspected. Early diagnosis is easier with recent event of new imaging techniques. (Ultrasonography and computerized tomography). Percutaneous drainage with the help of antibiotics is the treatment of choice: it is actually a very safe and efficient procedure.

Adolescent↗