PubMed Health⌕ Search

Biomedical subjects

M D Destable

Publications and source records attributed to M D Destable.

16 recordsLinked to original sources
PubMed1998

Videothoracoscopic lung biopsy in diffuse infiltrative lung diseases: a 5-year surgical experience.

BACKGROUND: To establish an accurate diagnosis of diffuse infiltrative lung disease, a surgical lung biopsy may be required. We report our experience with video-thoracoscopic lung biopsy over a period of 5 years. METHODS: From March 1992 through December 1996, videothoracoscopic lung biopsy was performed in 64 patients (17 were women [26.5%]; age, 50.5+/-13 years) with a diagnosis of diffuse infiltrative lung disease of an unknown cause. All patients except one received general anesthesia. Single lung ventilation was used in 61 patients. All lung biopsies were obtained with an endoscopic stapler. RESULTS: Single lung biopsies were performed in 39 patients (61%), two biopsies in 23 patients (36%), and three biopsies in 2 patients. Minithoracotomies were necessary in 10 patients (15.6%) owing to an iatrogenic pulmonary wound (1 patient), extensive pleural adhesions (6 patients), and a stiff lung (3 patients). Postoperative complications were rare and included five discrete pneumothoraces (7.8%), all resolving spontaneously, one prolonged air leak (1.6%), and one hemothorax requiring reoperation. Three preoperatively debilitated patients died (4.7%), 2 with progression of respiratory failure and 1 owing to septic shock. Average chest tube duration was 2.4+/-2 days and average hospital stay was 4.6+/-2.5 days. Lung biopsy contributed to the diagnosis in 59 patients (92%). CONCLUSIONS: Videothoracoscopic lung biopsy using an endoscopic stapler is a safe and effective procedure in most cases and should be performed by trained thoracic surgeons.

Biopsy↗
PubMed1994

[Peri-operative chemotherapy during resection of pulmonary metastases of sarcoma].

The objective of this prospective study was to evaluate the mortality and morbidity of sarcoma pulmonary metastasis resection with continuous chemotherapy. Ifosfamide was administered at the daily dose of 1200 mg/m2/24 h. Twenty-six resections of pulmonary sarcoma were performed from December 1990 to April 1992. The primary lesion was already resected in all patients. Peri-operatory chemotherapy was started 30 minutes before surgery and continued for 6 days. Chemotherapy was associated with an uroprotector, antiemetic drugs and adequate hydration. Patients had a mean age of 30.6 years. The delay between initial and thoracic surgery was 81 months. The following was performed: tumorectomy (32), wedge (18), lobectomy (7), diaphragm resection (1), left pneumectomy (1). All patients had the 6-days chemotherapy course. None of the patients died. Respiratory failure following superinfection, but not necessitating assisted ventilation, was observed in one case. The following adverse events were noted: nausea (34.6%), uncomplicated cystitis (15.4%), leucopenia (7.6%), fever (3.8%). Mean duration of hospitalization was 11.8 days. Chemotherapy adverse effects did not result in significant morbidity. Bronchial fistula was not observed. Following the results of this pilot study, we feel that perioperatory chemotherapy can be added to sarcoma pulmonary metastasis resection surgery without increasing patient morbidity and mortality.

Adult↗
PubMed1993

[Carcinosarcoma of the breast. Anatomic-clinical study of a case].

The authors report the case of a 66 year old woman, who underwent surgery for carcinosarcoma of the breast. This tumour consisted of an infiltrating ductal carcinoma intermingled with sarcomatous proliferation, resembling malignant fibrous histiocytoma, without evidence of any transition between the two. Carcinosarcomas of the breast are rare tumors. Their definition and their histogenesis are discussed in the literature. Their prognosis is worse than that of metaplastic carcinomas of the breast, particularly spindle cell carcinomas, justifying precise histological classification of these biphasic tumors.

Aged↗
PubMed1991

Fibrocystic disease of the breast in premenopausal women: histohormonal correlation and response to luteinizing hormone releasing hormone analog treatment.

Sixty-six patients with fibrocystic mastopathy were enrolled in the trial after being selected according to clinical, radioultrasonographic, and histologic criteria. No characteristic hormonal profile was noted in most patients (52%). Estrogen receptors or progesterone receptors, or both, were found in 57% of patients. Hormone receptor levels were correlated with atypical proliferative mastopathy (87.5%). Mastopathy was associated with a uterine fibroma or a fibromatous uterus in 73% of cases. All patients received intramuscular injections of a sustained delivery system (microcapsules) of luteinizing hormone releasing hormone agonist [D-Trp6]-LHRH, Ipsen-Biotech, Paris) for 3 to 6 months. In case of partial response at 3 months, an antiestrogen (tamoxifen, 40 mg/day, for estrogen receptor-predominant lesions) or a progestin (cyproterone acetate, 50 mg/day, for progesterone receptor-predominant lesions) was added to the luteinizing hormone releasing hormone agonist. A complete response was observed in more than half of the patients (n = 35, 53%) treated by [D-Trp6]-LHRH alone (n = 29) or associated with tamoxifen (n = 4) or cyproterone acetate (n = 2). A significant partial response was observed in 30 other patients (45%). Additionally, half of them received inhibitory drugs. The best responses were seen with cyst reformation (complete response, 100%) and fibrous block. Clinical responses to treatment with [D-Trp6]-LHRH alone were independent of hormone receptor status, but synergistic effects occurred with concomitant use of the corresponding inhibitory drugs. We conclude that chronic mastopathy, particularly when associated with uterine fibroma, can be successfully treated by luteinizing hormone releasing hormone analogs in premenopausal women.

Adult↗
PubMed1991

[Free-flap coverage technique with double vascular bypass in the lower limb].

In thirteen patients, the repair of a soft tissue defect of the lower limb required a free tissue transfer revascularized by microvascular grafts. The indication of vascular grafting was either the absence of vessels or inadequate recipient vessels. Proximal anastomoses were performed on the femoral artery and the femoral vein or the long saphenous vein. All the transfers were done in one stage procedure. In two cases, a transitory arteriovenous shunt was established. Three flaps out of thirteen have been lost by thrombosis. The discussion concerns the causes of the failures and the indication of the establishment of a transitory or a temporary arterioveinous shunt prior to free flap transfer.

Adult↗
PubMed1989

[Thoracic splenosis].

Thoracic splenosis is the autotransplantation of splenic tissue in the thorax after an injury of the spleen with a tear of the hemi-diaphragm. Usually, there is no symptom and it is unfrequent. A scintigraphy with 99 m. Tc. sulfur colloid and a scan with 99 m. Tc. tagged-heated red cells give the diagnosis. For now, it is no necessary to operate these patients to remove these thoracic nodules.

Choristoma↗
PubMed1989

[The association of lung cancer and atheromatous arterial disease].

This work is based on the retrospective study of the case history of 26 patients who were treated between September 1979 and January 1987 in the department of thoracic and vascular surgery at the Avicenne Hospital--and who were all suffering from both lung cancer and atheromatous arterial disease. It is now well established by all the epidemiologic research that the link between lung cancer and atheromatous arterial disease is smoking tobacco. The risks involved in the misunderstanding of such an association are not without danger for the patient, particularly the risk of severe complication of possible coronary or carotid lesions, threatening survival; from this derives the necessity to decide automatically for a minimum of pre-surgery vascular investigations in the case of patients suffering from lung cancer. The therapeutic strategy in this association must be thorough, considering that there are three priorities in the vascular field which must absolutely be treated before the lung itself: --the coronary and carotid lesions which are likely to be complicated cancer after surgery and any state of emergency in the other vascular territories. The fight against tobacco smoking must also be considered as a priority aim.

Aged↗
PubMed1987

[Thoracic wounds. Therapeutic approach. Apropos of 77 cases].

We have led over a four year period, from 1981 to 1985, a prospective study on all cases of penetrating chest wounds (77 cases) in the intensive Care unit and the Department of Thoracic Surgery at the Avicenne Hospital. These wounds, involving young males, are fortunately mostly benign. Their seriousness is based on the abdominal or mediastinal hemorrhage as well as lesions to the vital organs which need an emergency intervention. The latter, nevertheless, with the help of the mobile reanimation service for transfering the patient, has diminished the mortality rate to 2.6 per cent. Following their experiment and after a review of the literature, the authors expose their method of management of the penetrating chest wounds.

Adult↗
PubMed1986

[Pericardioscopy: definition, value and limitation].

After thoracoscopy and mediastinoscopy, pericardioscopy now completes the endoscopic techniques available for exploration of the pericardial cavity. During one year, we systematically associated pericardioscopy with pericardial drainage, using a mediastinoscope. Pericardioscopy visualizes the pericardium and guides biopsies. We report here this one-year experience of 12 pericardioscopies, describing the technique and listing its indications.

Adult↗
PubMedDate not supplied

[Implantable infusion devices. Experience of 360 cases].

Between january 1, 1983 and december 31, 1986, 360 implantable infusion devices were inserted for systemic chemotherapy. Most of the devices were Port A Cath systems. The main complications observed were thrombosis (18 cases, 5%) and infection (8 cases, 2.2%). Since one year the catheters are being introduced by subcutaneous puncture of the subclavian vein, the chambers being placed in a small lateral subclavicular cavity. Intra-operative radiography is necessary to minimize the risk of malposition and thrombosis. These systems, relayed by external pumps, enable chemotherapeutic regimens to be administered sequentially over a 24-hour period.

Humans↗