Extrapleural hematoma as a late complication of collapse therapy for tuberculosis.
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Aged↗
Biomedical subjects
N Roeslin
Publications and source records attributed to N Roeslin.
[Lobectomy extended to the main bronchus in the treatment of bronchial cancer (seventy-three cases)].
Sleeve allow excision of bronchial carcinoma in patients not able to functionally tolerate pneumonectomy. Our series consists of 73 patients operated over the last thirty years. Implantation of the bronchus was treated either by wedge resection or by complete resection followed by reimplantation. This procedure was performed for respiratory functional reasons in 39 cases (53%), on principle in 27 cases (37%) and in palliative indications in 7 cases (10%). The high perioperative mortality (6.8%) and morbidity (20%) were related to bronchovascular complications which were eliminated over the last decade. Local recurrences (23%) were more frequent than following conventional resections. On the other hand, the survival, 80% at one year, 62% at 2 years, 54% at 3 years and 39% at 5 years, related more to metastatic dissemination than to local recurrence, was comparable to that of the control group of pneumonectomised patients. This procedure gave identical results in terms of survival, but should be reserved for patients with respiratory failure due to the increased risk of local recurrence.
Adult↗
[Forgotten mediastinal goiter: seven cases].
The authors relate their experience with 7 cases of mediastinal goiter residual to a subtotal thyroidectomy for substernal goiter. The differential diagnosis with ordinary recurrence was based on the absence of connection with the cervical remnant. The reasons for surgical decision-making was mediastinal compression in 4 patients, hyperthyroidism in 1 patient and absent diagnosis in 1 patient; surgery was systematic in 1 asymptomatic patient. Sternal splitting incision was required in 6 patients: alone in 3, associated with cervical incision in 3 others; excision by an exclusively cervical route was possible in one patient. No malignancy was discovered. Postoperative outcome was uncomplicated in all patients. The residual goiter has the same clinical and paraclinical presentation as the ordinary intrathoracic goiter; treatment should be principally surgical for the same reasons. Nevertheless, for this mediastinal tumor, sternum-splitting incision will be required in most cases.
Aged↗
[Complications and mortality of surgery for bronchogenic cancers].
Resection surgery for lung cancer is beset with specific or non-specific complications which often darken the prognosis for life. The specific complications, related to surgical dissections, are mainly per- and postoperative haemorrhages of various origins and, less frequently, disturbances in respiration, nerve wound or chylothorax. Soon after pneumonectomy a bronchial fistula encouraged by different factors may appear (3.3% of the cases) and empyema, usually caused by staphylococci, may develop (3%). Non-specific complications may disturb the post-resection period, involving the lungs (atelectasia, parenchymal infections, acute respiratory failure) or the cardiovascular system (pulmonary embolism, dysarrhythmia). The overall perioperative mortality rate has decreased with time owing to advances in anaesthesia and intensive care: in the hands of certain medico-surgical teams it does not exceed 3%. It is significantly lower in lobar (mean: 4.5%) than in pulmonary (mean: 8.4%) resections. Enlarged resections and lymph node dissections are aggravating factors. Patients aged 70 or more do not tolerate these operations so well: their mean overall mortality rate is twice that observed in younger patients (8% on average and up to 20%). Resection surgery for lung cancer remains a necessarily hazardous procedure but is the only treatment that can cure the patient. Its success is directly conditioned by a good preoperative risk evaluation.
Age Factors↗
[What is the role of thoracoscopy in the preoperative staging of non-small cell bronchial cancer?].
It is of paramount importance to clearly separate the non small cell bronchogenic cancers involving the chest wall or the diaphragm (T3) and those metastasizing to the pleura (T4). In both events, surgery is either technically demanding or contraindicated. What is the contribution of thoracoscopy to diagnosis? Very few authors have used thoracoscopy in a restricted number of cases and with varying results to confirm tumoral extent to the chest wall. We are of opinion that this approach is only warranted in patients at major operative risk, in order to prevent an unprofitable thoracotomy. Concomitant pleural effusion as indication for thoracoscopy should be discussed with respect to the following data: 1) Among all bronchogenic cancers, 10% present with a concomitant pleural effusion detected on chest radiograms, 60% of which are metastatic. The significance of effusions disclosed by CT scan has not yet been established. 2) Pleural involvement inconsistently produces an effusion; the prevalence compiled from thoracotomies is varying according to the authors. 3) The sensitivity of thoracoscopy for the positive diagnosis of malignant effusions is about 95%. The concomitant pleural effusion is predictive of poor prognosis, but does not preclude operability. Cytology of thoracentesis specimens and pleural needle biopsy are the consistent first steps towards diagnosis; thoracoscopy should be restricted to the failures of these techniques.
Carcinoma, Non-Small-Cell Lung↗
Phase I trial of intravenous infusion of ex-vivo-activated autologous blood-derived macrophages in patients with non-small-cell lung cancer: toxicity and immunomodulatory effects.
The purpose of this phase I study was to evaluate the toxicity and biological activity of autologous blood-derived macrophages activated ex-vivo with recombinant human interferon gamma (rhuIFN gamma) [monokine-activated killer (MAK) cells] and administered intravenously to 11 lung cancer patients once a week for 6 consecutive weeks. Peripheral blood monocytes were collected by leukapheresis and then purified by counterflow elutriation. The MAK cells were generated by culturing the purified monocytes in Teflon bags for 7 days and adding rhuIFN gamma to the cultured cells for the last 18 h. These MAK cells expressed differentiation-associated surface antigen MAX1, and were cytotoxic in vitro against tumour cell line U937. The MAK cells were infused at dose levels from 1 x 10(7) to 5 x 10(8) on an intrapatient dose-escalating schedule. No severe adverse side-effects occurred. Toxicity was mild to moderate [primarly fever (75%) and chills (32%)], non-dose-dependent, and non-cumulative. No consistent change in haemostatic function, or liver or renal function was observed. Dose-limiting toxicity was not reached at 5 x 10(8) cells (optimal dose reproduced for each patient). The maximum tolerated dose was not determined. The immunomodulatory activity of i.v. infused MAK cells was demonstrated both in vivo by significant increases in granulocyte count and neopterin level in the patients' peripheral blood post-infusion and in vitro by secretory products (IL-1. TNF alpha, neopterin, and thromboplastin-like substance) in the culture supernatants. The in vivo traffic patterns of autologous MAK cells labelled ex-vivo with 111In oxine were studied in 7 patients. Gamma imaging showed an immediate but transient lung uptake (less than 24 h), and a progressive uptake of radioactivity in the liver and spleen was seen from 6 h to 72 h post-infusion. Our results indicate that the preparation of high numbers of autologous, blood-derived MAK cells is a feasible procedure, and their transfusion is safe for patients. This immunotherapeutic approach seems to be encouraging from the point of view of establishing an adjuvant therapeutic modality in cancer patients with minimal residual disease.
Aged↗
Emergency repair of main stem bronchus disruption complicated by anastomotic stenosis: two cases of successful repair by resection and reanastomosis.
The case reports of two patients who developed complete bronchial stenosis after emergency repair of a left stem bronchus disruption are reported. Resection of the stenotic bronchus and reanastomosis restored a normal lung function in both patients. Arguments for a conservative approach, perioperative investigations, and technical data are discussed.
Accidents, Traffic↗
[Non-aplastic N2 operated bronchial cancers. Multifactorial analysis of the prognosis].
The marked disparity of the published 5-year survival rates (0 to 3%) for non-anaplastic, operated N2 lung cancers would suggest the marked heterogeneity of the patients studied. We prospectively studies 97 N2 tumours for which "curative" resection was performed between 1983 and 1986. The overall survival rate was 28% at 3 years, 19% at 4 years and 12% at 5 years. Survival was studied on the basis of several parameters concerning the tumour: histological type and degree of differentiation, T (TNM), modality of invasion (circumscribed, infiltrating), the quality of the stroma (absent, fibrotic, cellular), the mitotic index, the necrosis rate, presence or absence of microscopic invasion of blood vessels; and concerning the nodes: site, number (solitary, multiple), size of the metastasis (massive, microscopic), macroscopic or microscopic invasion of the capsule. We know the outcome for all of our patients: 81 have died and 16 are still alive. Sixty-one have developed metastases, 5 have developed local and regional recurrences and 3 have both a recurrence and metastases. Univariate analysis demonstrated that a small number of parameters significantly influence survival: microscopic invasion of blood vessel (chi 2 = 5.24, p less than 0.02), macroscopic and microscopic invasion of the lymph node capsule. In order to more clearly define the prognostic factors, we used Cox's multidimensional model. This model was applied to the three significant parameters to which we added two other variables which non-significantly tended to be related to survival: tumour necrosis and number of lymph nodes involved.(ABSTRACT TRUNCATED AT 250 WORDS)
Adenocarcinoma↗
[Precordialgia caused by idiopathic pneumomediastinum].
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Adult↗
[The risks of surgical training. A study apropos of 348 pneumonectomies].
On the basis of the retrospective study of a series of 348 pneumonectomies, the authors have attempted to assess whether the risks of postoperative complications were increased if the operation was carried out by trainee surgeons. All operations were performed for cancer, with a stapler being used for bronchial suture. The patients were classified in three groups according to the surgeon: 133 (38%) were operated by an University professor (group I, 2 surgeons), 171 (49%) by chief resident or hospital practitioner (group II, 3 surgeons) and 44 (13%) by an intern (group III, 14 surgeons). The homogeneity of the 3 groups was checked with alpha X2 test. The study dealt with the overall mortality as well as with the specific complications of pneumonia, namely empyema and bronchopleural fistulae. The overall postoperative mortality rate was similar in the 3 groups (respectively 8%, 8% and 5%), as well as the occurrence of empyema (respectively 4%, 3% and 5%). A difference that, though not significant statistically, is not negligible, appears for bronchopleural fistulae, which complicate 9% of the operations carried out by interns vs. 4% in the other 2 categories. These observations challenge a number of studies claiming that surgery performed by inexperienced surgeons is innocuous. However, pneumonectomy is an essential step in the training to thoracic surgery, so that no candidate with sufficient surgical maturity should be prevented from performing it.
Female↗
[Long-term outcome of surgically treated bullous emphysema].
The long term outcome for 88 patients with bullous emphysema who had operations was analysed from the clinical, respiratory function and occupational point of view. In order to reduce to the minimum any bias which would be likely to appear as a result of a decrease in the number of patients with time respiratory function parameters were compared to those of a restricted number of patients for whom we knew all the values for each period determined. Before the operation all the patients showed radiological signs of bullous emphysema; the respiratory function measurements in 66 of them showed bronchial obstruction with distension, hypoxaemia at rest without hypercapnia. The clinical follow up and respiratory function was spread over more years. It showed a post operative improvement in dyspnoea which was perceptible in 77% of patients at 2 years, 68% at 3 years, 60% at 4 years, 51% at 5 years, 32% at 10 years. 2/3 of the patients who were working before the operation had taken up their normal work following it. the survival levels were 86% at 1 year, 83% at 2 years, 80% at 3 years, 78% at 4 years, 77% at 5 years, 73% at 6 years, 73% at 6 years, 58% at 10 years. Of 20 patients who died 12 had died of respiratory failure. All the spirographic parameters had improved following the operation but a secondary deterioration was noted around the 5th post operative year for the vital capacity, and at the third year for residual volume, FEV 1, and the FEV 1/VC ratio as well as PAO2.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[Exploratory thoracotomy of necessity in surgery of bronchial cancer].
The survey conducted by the French Language Society of Thoracic and Cardiovascular Surgery collected a total of 2,962 exploratory thoracotomies for lung cancer performed over a period of 10 years. Over the same period, 25,291 operations were performed for lung resection, so that the mean rate of exploratory thoracotomy was therefore 11.7%. The rate of exploratory thoracotomy varied from one unit to another (2.7% to 45.8%) and appeared to be virtually independent of the operative activity. It has continued to decrease over time, which is even more significant in view of the fact that the operative activity has increased in all of the units. The local and regional spread of the tumour represents the principal reason for non-resection (79% of cases); it was less common in units with a high operative activity (72%) than in other units (84%) especially when the mediastinal lymph nodes were involved. The major thoracic surgery units also appear to be distinguished by a greater audacity, as well as an increased failure rate in the case of tumour spread to the trachea. The risk of exploratory thoracotomy is considerable as it was responsible for death in 3% of cases. A better radiological and clinical assessment, rather than the use of mediastinoscopy should avoid 2% of these useless explorations. The subsequent course of these patients barely concerns the surgeon: it is rapidly unfavourable and the rare long-term survivals (2% at five years) are not sufficient to justify operation at any cost.
Bronchial Neoplasms↗
[Development of 62 typical carcinoid tumor of the bronchi surgically treated. Prognostic value of histopathological features].
The pathological and clinical features of 62 carcinoid tumours of the bronchus operated between 1975 and 1987 were reviewed in order to determine the prognostic value of certain parameters: limit of proliferation, vascular invasion, lymph node involvement. This series corresponded to 36 central tumours and 25 peripheral tumours, all treated surgically. One patient was lost to follow-up, 3 developed recurrences, 56 are still alive without recurrence and 3 died from intercurrent causes. The histological appearance of the tumours was homogeneous and typical. Twenty-eight lesions were strictly intrabronchial, 34 invaded the lung with incomplete limits in twenty cases. The tumour showed signs of vascular invasion in ten cases and the adjacent lymph nodes were invaded in eight cases. The local recurrence was undoubtedly related to an excessively conservative primary resection, as the primary tumour did not demonstrate any unusual features. The two tumours which metastasized showed vascular invasion: one metastasized to a hilar node, but these features were observed in other cases which retained a benign course. The standard histological diagnosis of typical carcinoid tumour does not appear to raise any particular difficulties; it is reliable. The course of the disease is sometimes malignant but no histological parameter is able to accurately predict this outcome.
Adult↗
[Perfusion scintigraphy and surgical excision of bronchial cancers].
In a series of 1,800 operated lung cancers, 93 had a unilateral perfusion scan less than or equal to 20% (36 perfusions = 0, 15 between one and 10% and 42 between 11 and 20%). Major amputations were more frequent on the left side and constituted a pejorative but non-decisive factor for surgical nonintervention although was not synonymous with inoperability. The extent of the resection increased with the severity of the amputation.
Carcinoma, Bronchogenic↗
[Outcome of 100 necessary exploratory thoracotomies for bronchial cancer].
The outcome of one hundred exploratory thoracotomies for lung cancer (9.1% of operations) was studied. There were 4 postoperative deaths. After the operation, 6 patients did not receive any further treatment, 62 received radiotherapy, 25 received a combination of radiotherapy and chemotherapy and 3 received chemotherapy. The disease-free interval was very short with development of metastases (55 cases) and local recurrences (29 cases). The survival was also short: less than 10% at 2 years; it was significantly poorer than that observed in a group of non-operated patients with an equivalent stage of lung cancer. These findings suggest the need for stricter evaluation of operative indications.
Aged↗
Surgery for intrathoracic metastases from renal-cell carcinoma.
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Adult↗
Immunotherapy as an adjuvant to surgery in carcinoma of bronchus. Results in three randomised trials.
The results of non-specific immunotherapy adjuvant to surgery in the treatment of non-small cell lung cancer were studied in three separate randomised clinical trials involving 344 patients. The first study involved 126 patients. In 73, intrapleural BCG was given according to McKneally's technique. They were compared to a control group of 63 patients. In the second trial, levamisole was administered to 43 patients who, in addition to surgery, also had radiotherapy. These were compared with 43 control patients. In the third study, 60 patients underwent surgical operation for limited lesions and in addition received Isoprinosine. These were compared with a control group of 60 patients. All patients in the control groups of the three studies had similar surgical operations to their treated counterpart. The overall results showed no difference between those who received immunotherapy and the control groups of patients and that the use of these agents did not alter either the course of the disease or the incidence of its recurrence.
Adenocarcinoma↗
[Bronchiolo-alveolar carcinoma. Anatomo-pathological and evolutional study of a series of 52 operated cases].
The postoperative outcome of bronchiolo-alveolar epithelioma (EBA) is unpredictable. We question whether a study of the anatomo-pathological structures would enable us to detect prognostic indicators. The clinical characteristics, histopathology and outcome of 52 cases of EBA were studied. 31 tumours were detected in a systematic fashion; 50 patients had excision of the tumour and in 39 cases there was no invasion of the lymphatics. 10 were of the multicentric variety and 42 were of the nodular variety and 9 of these were the centre of an inflammatory lympho-plasmocytic reaction. 20 cases revealed mucinous differentiation and 32 were non-mucinous. In the latter cases nucleo-cytoplasmic anomalies were only slightly increased or even absent. Blood vessel invasion was present in 12 cases and metastases to the air spaces in 20. The overall survival was 83% in the first year, 65% in the second year, 42% at five years and 26.5% at 10 years. The nodular lesions were compatible with a significantly better survival than the diffuse forms. Other characteristics such as whether the tumour was mucinous or not, inflammatory, showed nuclear anomalies, blood vessel invasion and airborne metastases did not seem to affect survival.
Adenocarcinoma, Bronchiolo-Alveolar↗