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Biomedical subjects

Loïc Lang-Lazdunski

Publications and source records attributed to Loïc Lang-Lazdunski.

18 recordsLinked to original sources
PubMed2006

Catamenial pneumothorax: surgical repair of the diaphragm and hormone treatment.

Catamenial pneumothorax is defined as spontaneous pneumothoraces occurring within 72 h before or after onset of menstruation. It is rare but clinical index of suspicion should be high in ovulating women with spontaneous pneumothoraces. The mechanism is unclear but is thought to involve pre-existing or acquired diaphragmatic defects and endometrial implants. Traditional therapy involving hormonal treatment or surgical pleurodesis alone is associated with high rates of recurrence. A series of four patients with catamenial pneumothorax managed at our institution is presented to highlight the condition to various surgical specialties to whom it may present, and to emphasise the importance of both surgical and hormonal interventions in preventing recurrence. Each patient underwent video-assisted thoracoscopic inspection of the diaphragm, mechanical pleurodesis and, most importantly, repair of diaphragmatic defects with an artificial mesh. Surgical treatment was strictly followed by a course of gonadotrophin-releasing hormone analogue therapy in three patients, with no recurrence to date (longest follow-up 45 months). The fourth patient suffered a postoperative recurrence when hormonal treatment was delayed for 6 weeks, stressing the importance of hormonal treatment in conjunction with surgery.

Adult↗
PubMed2005

Primary extramedullary hematopoiesis manifesting as massive bilateral chylothorax.

Intrathoracic extramedullary hematopoiesis is a rare entity, mostly observed in patients with hematologic disorders. Extramedullary hematopoiesis is usually asymptomatic and is often located in the lower paravertebral sulci and rarely in the pleura. We report the case of a 54-year-old man without hematologic disorder or pleural malignancy who had a massive bilateral chylothorax develop due to primary pleural extramedullary hematopoiesis. He was successfully treated by bilateral video thoracoscopic talc pleurodesis and low-dose radiotherapy.

Chylothorax↗
PubMed2004

Repair of the descending thoracic aorta: impact of open distal anastomosis technique on spinal cord perfusion, neurological outcome and spinal cord histopathology.

OBJECTIVES: We investigated the impact of equilibrating distal aortic pressure with atmospheric pressure (open distal anastomosis) on spinal cord perfusion, neurological outcome and spinal cord histopathology in a rat model of descending thoracic aortic surgery. METHODS: Proximal thoracic aortic occlusion was obtained in Sprague-Dawley rats by inflating the balloon of a 2F Fogarty catheter introduced through the left femoral artery. Rats were separated into three groups: sham-operation (n = 5) without balloon inflation, control (n = 15) with inflation of the balloon, and open distal (n = 15) with inflation of the balloon combined with incision of the right femoral artery to allow free drainage of distal aortic blood. Balloon inflation was maintained for 15 min. Rectal temperature, arterial blood gases and pH, distal arterial blood pressure (DABP) and lumbar spinal cord blood flow (SCBFl) were recorded throughout the procedure. Neurobehavioral status was assessed daily using a 0-5 scale and rats were sacrificed after 48 h of reperfusion and their spinal cord harvested for histopathology and immunohistochemistry for microtubule-associated protein-2 (MAP-2). RESULTS: DABP and SCBFl values were lower during thoracic aortic occlusion in the open distal group, compared to the control group (P < 0.001). Paraplegia and mortality rates were dramatically increased in the open distal group (87.7 and 46.6%, respectively) compared to the control group (0 and 6.6%, respectively, (P < 0.001 and 0.02). Severe metabolic acidosis and bowel infarct were also more frequent in the open distal group (P < 0.001). Sham-operated and control rats had virtually normal spinal cords, whereas rats in the open distal group had severe ischemic injury throughout gray matter. CONCLUSIONS: Equilibrating distal arterial pressure with atmospheric pressure during thoracic aortic occlusion decreased spinal cord blood flow, increased mortality and worsened spinal cord injury in rats. These results suggest that the open distal anastomosis technique should be used with caution in patients undergoing repair of the descending thoracic or thoracoabdominal aorta.

Anastomosis, Surgical↗
PubMed2004

A prospective study of autologous 'blood patch' pleurodesis for persistent air leak after pulmonary resection.

OBJECTIVE: To evaluate the efficacy and risks of autologous 'blood patch' pleurodesis in patients with persistent air leak after pulmonary resection. METHODS: All patients operated on by a single surgeon between January 2002 and January 2004 and presenting with a persistent air leak after pulmonary resection have been treated by the autologous blood patch pleurodesis technique. Fifty millilitres of autologous blood were injected through the chest tube that was then rinsed, clamped for 30 min and then unclamped and placed back to water seal. RESULTS: We have obtained a 100% success rate in 11 patients with persistent air leak who have been treated with this technique over a 2-year period. Most air leaks (72.7%) ceased within 12 h of blood injection. No patient developed empyema, but two patients developed fever and pleural fluid grew Staphylococcus after blood pleurodesis. At 3-month follow-up, all patients were well and their lungs were expanded fully. CONCLUSIONS: In our experience a single injection of 50 ml of blood is sufficient to seal persistent air leaks in less than 48 h. Although highly effective, the autologous blood patch pleurodesis technique should not be used in patients with incomplete lung re-expansion or positive pleural fluid culture to minimize the risk of empyema.

Adult↗
PubMed2003

Videothoracoscopic resection of neurogenic tumors of the superior sulcus using the harmonic scalpel.

Resection of neurogenic tumors located in the paravertebral sulcus carries a risk of injury to the adjacent nervous structures and also to critical intercostal arteries supplying the anterior spinal artery. To avoid such complications, we have used the Harmonic Scalpel (Ethicon Endo-Surgery, Cincinnati, OH) for the dissection of neurogenic tumors in 2 consecutive patients operated on by videothoracoscopy. The Harmonic Scalpel functions with ultrasonic energy, producing less heat than a regular electrocautery and allows a safer dissection of tumors located in the posterior mediastinum, particularly those located in the superior paravertebral sulcus.

Electrocoagulation↗
PubMed2003

Videothoracoscopic bleb excision and pleural abrasion for the treatment of primary spontaneous pneumothorax: long-term results.

BACKGROUND: The goal of this study was to evaluate the long-term efficiency of videothoracoscopic bleb excision and pleural abrasion for the treatment of primary spontaneous pneumothorax. METHODS: From July 1991 to December 1997, 182 patients with primary spontaneous pneumothorax were treated by a single technique at our institution. Seven patients had single-stage bilateral procedures and 11 other patients had staged bilateral procedures. Indications for operation were first episode with prolonged air leak, incomplete lung reexpansion, or job restrictions (n = 59), first ipsilateral recurrence (n = 57), second or third ipsilateral recurrence (n = 34), contralateral recurrence (n = 25), synchronous bilateral pneumothorax (n = 3), hemopneumothorax (n = 3), and tension pneumothorax (n = 1). All patient data were reviewed retrospectively, and 167 patients were available for late follow-up (92%). RESULTS: Mean operative time was 57 +/- 19 minutes. Conversion to thoracotomy was required in 1 patient (0.6%). Mean duration of pleural drainage was 5.8 +/- 1.2 days (range, 4 to 26 days), and mean postoperative stay was 7.7 +/- 1.6 days (range, 6 to 31 days). Postoperative complications occurred in 50 patients (27.4%), the most frequent being prolonged air leak (14.8%), and in-hospital mortality was 0%. After a mean follow-up of 93 +/- 22 months (range, 57 to 134 months; median, 84 months), five ipsilateral recurrences were noted (3%). Three recurrences occurred within 12 months of videothoracoscopy and required reoperation. Two patients had partial pneumothorax recurrence at 39 and 58 months, and were treated conservatively with chest tube insertion and tale slurry. After 1 year, 10.7% of patients complained of chronic chest pain or discomfort, although none was taking pain medication after 3 months. Most patients (89.8%) were satisfied or very satisfied of their operation. All patients had returned to sport activities within 2 years. CONCLUSIONS: Videothoracoscopic bullectomy and pleural abrasion is a reliable and safe method to treat primary spontaneous pneumothorax. Long-term recurrences occur with an acceptable rate that compares with results after limited thoracotomy. Chronic chest pain or discomfort is unpredictable and may represent a problem in a few patients.

Adolescent↗
PubMed2003

Malignant "Triton" tumor of the posterior mediastinum: prolonged survival after staged resection.

Malignant "Triton" tumor is a rare subtype of malignant peripheral nerve sheath tumor showing rhabdomyoblastic differentiation. We report the case of a 22-year-old patient who had excision of such a tumor by video-assisted thoracic surgery. He was reoperated on by thoracotomy 2 months later and received adjuvant radiation, with prolonged survival. Radical surgical excision of malignant Triton tumor followed by adjuvant radiation therapy may provide the longest survival and represent the treatment of choice.

Adult↗
PubMed2003

Linolenic acid prevents neuronal cell death and paraplegia after transient spinal cord ischemia in rats.

PURPOSE: Spinal cord ischemia is a devastating complication of thoracic and thoracoabdominal aortic surgery. Recent studies have suggested a neuroprotective effect of polyunsaturated fatty acids against cerebral ischemia. We investigated the effect of linolenic acid (LIN) in a rat model of spinal cord ischemia. METHODS: Rats were subjected to cross-clamping of the aortic arch and left subclavian artery for 14 minutes. Groups were as follows: sham operation (n = 15); ischemia (n = 15), receiving only vehicle; LIN A (n = 15), receiving LIN before clamping; and LIN B (n = 15), receiving LIN at onset of reperfusion. Neurologic status was assessed daily for 7 days. Spinal cords were harvested for histopathologic analysis, TUNEL staining, and immunohistochemistry for Bax, heat shock protein 70 (HSP70), and nuclear factor-kappaB. RESULTS: Ischemic rats had severe and definitive paraplegia. LIN-treated rats had significantly better neurologic function. Histopathologic analysis disclosed severe neuronal necrosis in the lumbar gray matter of ischemic rats, whereas most of the LIN-treated rats sustained mild to moderate injury. LIN reduced the loss of motor neurons at 7 days (LIN A, 17 +/- 6, and LIN B, 15 +/- 7, versus ischemia, 6 +/- 2 per section; P <.05). LIN prevented apoptotic neuronal cell death, Bax immunoreactivity of the pro-apoptotic protein Bax, and the nuclear transcription factor NF-kappaB. Nuclear HSP70 immunoreactivity was noted exclusively in motor neurons from LIN-treated rats and not in motor neurons from ischemic rats. CONCLUSION: These results suggest that LIN can induce protection against ischemia in the spinal cord, thereby preventing both necrosis and apoptosis of motor neurons.

Analysis of Variance↗
PubMed2003

VEGF is a modifier of amyotrophic lateral sclerosis in mice and humans and protects motoneurons against ischemic death.

Amyotrophic lateral sclerosis (ALS) is an incurable degenerative disorder of motoneurons. We recently reported that reduced expression of Vegfa causes ALS-like motoneuron degeneration in Vegfa(delta/delta) mice. In a meta-analysis of over 900 individuals from Sweden and over 1,000 individuals from Belgium and England, we now report that subjects homozygous with respect to the haplotypes -2,578A/-1,154A/-634G or -2,578A/-1,154G/-634G in the VEGF promoter/leader sequence had a 1.8 times greater risk of ALS (P = 0.00004). These 'at-risk' haplotypes lowered circulating VEGF levels in vivo and reduced VEGF gene transcription, IRES-mediated VEGF expression and translation of a novel large-VEGF isoform (L-VEGF) in vivo. Moreover, SOD1(G93A) mice crossbred with Vegfa(delta/delta) mice died earlier due to more severe motoneuron degeneration. Vegfa(delta/delta) mice were unusually susceptible to persistent paralysis after spinal cord ischemia, and treatment with Vegfa protected mice against ischemic motoneuron death. These findings indicate that VEGF is a modifier of motoneuron degeneration in human ALS and unveil a therapeutic potential of Vegfa for stressed motoneurons in mice.

Aged↗
PubMed2002

Videothoracoscopic splanchnicectomy for intractable pain from adrenal metastasis.

Splanchnicectomy has been known for years as a treatment for refractory pain in patients with pancreatic cancer or chronic pancreatitis. We report herein the performance of a videothoracoscopic left splanchnicectomy in a patient with a previous right pneumonectomy who suffered intractable pain from an irresectable left adrenal metastasis associated with metastatic retroperitoneal lymph nodes. Immediate pain relief was obtained, but abdominal pain of middle intensity recurred 6 weeks later. Although infrequently required, this procedure might be of value in some patients with refractory pain.

Abdominal Pain↗
PubMed2002

Characteristics and prognosis of resected T3 non-small cell lung cancer.

BACKGROUND: T3 tumors can be divided into several subgroups depending on the type of anatomical structure invaded: chest wall, mediastinal pleura, or main bronchus. The aim of this study was to analyze the characteristics and prognosis of each subgroup of T3 tumors. METHODS: The results of surgical treatment were retrospectively analyzed for 261 patients with T3 non-small cell lung cancer invading either the mediastinal pleura or parietal pericardium by direct extension (mediastinal pT3, n = 68), or main bronchus (bronchial pT3, n = 68), or chest wall (chest wall pT3, n = 125) that were operated on between 1984 and 1996. Complete resection including radical mediastinal lymph node dissection was intended in all patients. One patient had segmentectomy, 91 had lobectomy (34.9%), and 169 had pneumonectomy (64.8%). One hundred and fifty-eight patients received adjuvant radiation therapy and 7 patients received both adjuvant chemotherapy and radiation therapy. Actuarial survival curves were drawn using the Kaplan-Meier method and risk factors for late death were identified. RESULTS: In-hospital mortality was 6.1%. Follow-up was 98% complete. Global 5-year survival was 28%, with survival being not significantly different among the three subgroups: 34.9%, 30.6%, and 22.5% (p = 0.19) in the bronchial pT3, mediastinal pT3, and chest wall pT3 subgroups, respectively. Resection margins were microscopically invaded in 33 patients (12.6%). Seventy-four patients had N1 involvement (28.4%) and 78 patients had N2 involvement (29.8%). N0 involvement was more prevalent in the chest wall pT3 subgroup, whereas N1 involvement was more prevalent in the bronchial pT3 subgroup and N2 involvement was more prevalent among patients with mediastinal invasion. Pathologic factors influencing the 5-year survival were tumor size (p = 0.03) and N involvement (p = 0.003). Histology, type of surgical resection (lobectomy versus pneumonectomy), and use of adjuvant therapy did not influence survival significantly. CONCLUSIONS: Five-year survival was not significantly different among the three subgroups of pT3 non-small cell lung cancer, although bronchial pT3 tumors tended to have a better prognosis and chest wall pT3 tumors tended to have a worse prognosis. The pathologic characteristics of each pT3 subgroup seems different. Further research is warranted to explore the pathologic and biological factors influencing prognosis for each pT3 subgroup.

Adenocarcinoma↗
PubMed2002

Traumatic extrathoracic lung herniation.

Traumatic extrathoracic lung herniation is an exceptional complication of blunt chest trauma. We report the case of a 46-year-old man who was involved in a motorcycle accident and who suffered a left clavicle fracture-dislocation associated with multiple rib fractures and massive herniation of the left upper lobe through an upper anterior chest wall defect. Immediate surgical repair through an atypical transcostal vertical thoracotomy resulted in full recovery of pulmonary function at 1 year.

Clavicle↗
PubMed2002

Simultaneous bronchopleural and esophagopleural fistulas after pneumonectomy.

The simultaneous occurrence of bronchopleural fistula (BPF) and esophagopleural fistula (EPF) after pneumonectomy is very rare. We describe a 60-year-old man who developed empyema associated with bronchopleural fistula as a complication of a right pneumonectomy. Initial chest tube drainage and antibiotic therapy were ineffective. Five months later ingested food particles appeared in the drainage fluid. Esophagoscopy revealed an esophageal fistula of 10 mm in diameter. After nutritional support by feeding jejunostomy both BPF and EPF were repaired by subscapular muscle myoplasty and extensive thoracoplasty through a right thoracotomy. Endoscopic examination performed 1 month after surgery showed complete closure of both fistulas and 9 months after surgery the patient was eating and gaining weight. The patient's death was due to aspiration pneumonia of another origin.

Adenocarcinoma↗