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Biomedical subjects

P Blondeau

Publications and source records attributed to P Blondeau.

At least 19 recordsLinked to original sources
PubMed1994

[Substernal goiter: diagnostic and therapeutic problems (apropos of a personal series of 585 interventions)].

This retrospective study is based on a personal experience of 585 operations performed between 1958 and 1993. The diagnosis and topographic evaluation of the thoracic extension of a goiter were greatly improved by the development of the new imaging technics (CT Scan and RMN). Those rather expansive and complex technics were not necessary in 505 cases (86.3%), the diagnosis and topographic evaluation being easy from the conventional tests (X-ray, echography, scintigraphy). But in 80 cas (13.7%) either the diagnosis or the topographic evaluation were difficult or mistaken because Scan or RMN were not yet available or were not used (20 thoracic extensions overlooked; 26 separated thoracic goiters; 24 crossed thoracic extensions; 5 massive degeneration of thoracic extension; 5 false thoracic extension simulated by a mediastinal tumor). The surgical ablation of the substernal goiter could be achieved through a simple cervical approach in 96.4% of the operations. In 21 cases it appeared necessary to prolong the cervicomy by a median sternotomy (total and extrapleural sternotomy in all cases). The transternal approach was imposed in 9 cases by a profound and voluminous thoracic extension in contrast with a small cervical thyroid. In 5 cases, the reason was a massive malignant degeneration of the thoracic extension. In 7 patients the operation was done for a mediastinal redux after a previous cervical thyroidectomy having overlooked the thoracic extension. In spite of all the difficulties, all operations were successful with no mortality and a low morbidity (although slightly higher than the overall morbidity of thyroid surgery).

Goiter, Substernal↗
PubMed1992

[Is thyroid cancer a severe cancer? (Prognostic study of 800 surgically-treated cases of which 143 nodular differentiated cancers were followed-up for more than 20 years)].

The prognosis of thyroid carcinoma has always been difficult to appreciate because this rather rare carcinoma is polymorph and subject to some very late recurrencies. For these reasons an acceptable prognostic evaluation is only possible with an important material and very long follow-up. From 800 patients operated by the author, 102 (13%) had an extra-capsular tumor, which means for all authors a very poor prognosis. Still two groups must be separated: the anaplastic extracapsular tumors (33/102) gave a very low life expectancy with 17% survival at 5 years and no patient surviving at 8 years. In contrast the differentiated extracapsular tumors, mainly papillary, gave an unexpected survival rate of 35% at 15 years. The more frequent nodular form of differentiated carcinoma (698/800 = 87%) has a much better prognosis, but his slow evolution needs a long follow-up observation. From 160 patients operated on before 1971, 143 (90%) could be all followed during 20 years or more. The over-all survival rate at the 20th year is 83% with 76% of patients free of any recurrence. The analysis of several factors showed that the extension of the primitive operation (lobectomy or total thyroidectomy) does not influence the long term results. More reliable prognostic factors are the degree of histologic differentiation of the tumor, and the age of the patient. Finally, in spite of an excellent overall long-term prognosis, three very late recurrencies were observed in the group of 143 patients followed more than 20 years, respectively 21, 22 and 31 years after the first operation. This makes impossible the certitude of definitive cure of any thyroid cancer.

Cell Differentiation↗
PubMed1991

Embolization of cardiac myxomas masquerading as polyarteritis nodosa.

Cardiac myxomas are rare tumors which can mimic other diseases. We describe a 19-year-old man who presented clinically with polyarteritis nodosa (PAN). Muscle biopsy showed vasculitis, but corticosteroid and immunosuppressive therapy was initially effective. Cardiac myxomas were found by echocardiogram when the disease relapsed and were resected surgically. Segmental arterial aneurysms and stenoses were found on angiography after leg ischemia. We suggest that echocardiography should be performed in all cases of clinically suspected PAN.

Adrenal Cortex Hormones↗
PubMed1991

[Management of subrenal aneurysm of the abdominal aorta].

This update, intended for cardiologists, is not concerned with technical surgical considerations but rather considers the problems facing the physician in abdominal aortic aneurysm (AAA). 1) What form does AAA take: an atheromatous, spindle-shaped and partially thrombotic ectasis. 2) How is it detected: traditionally by clinical examination and increasingly by ultrasound. 3) What additional examinations are useful: the most simple and commonly repeated is ultrasound. Aortic angiography is useful only in cases with a surgical indication. 4) What is the risk of spontaneous development: above all, rupture, the statistical risk of which becomes considerable once the diameter of the aneurysm exceeds 6 cm. 5) What are the risks and results of surgical treatment: it has become an operation presenting little danger and one that beyond all doubt increases life expectancy. 6) Which patients should undergo surgery: all aneurysms dating from more than 6 cm and/or showing symptoms.

Aortic Dissection↗
PubMed1991

[Surgical treatment of hyperthyroidism (therapeutic and nosologic considerations from a personal experience of 2,395 cases)].

A retrospective analysis of the author's surgical experience (2,395 operations) demonstrates that the surgical treatment of hyperthyroid is nowadays simple and benign without mortality and with a very low morbidity. This dramatic improvement can be explained by the combination of a better medical preparation, and a meticulous surgical technic in the hands of an experimented team. The long term results are excellent with no recurrence of hyperthyroid. In about 30% of patients is observed a residual hypothyroid, which is milder, less evolutive and easier to manage than hypothyroid following radio-iodine therapy. Surgery thus appears in most cases to be the best solution, when the impossibility or failure of a medical treatment leads to consider a more radical approach. A classification of hyperthyroid lesions is proposed which seemed more suitable for the establishment of a rational surgical strategy. This classification is based on the opposition of diffuse hyperfunctional hyperplasia (with or without nodes) and localised toxic adenomas (single or multiple).

Humans↗
PubMed1990

Clinical features of adrenocortical carcinoma, prognostic factors, and the effect of mitotane therapy.

Adrenocortical carcinoma is a rare tumor, and only limited information is available about its natural history and the effects of therapy. We studied 105 patients (75 female and 30 male; mean age, 46 years) with adrenocortical carcinoma who were referred to us between 1963 and 1987. The average duration of symptoms before diagnosis was 8.7 months. At the time of diagnosis, 68 percent of the patients had endocrine symptoms, and 30 percent had distant metastases. Hormonal studies showed that 79 percent of the tumors were functional. Eighty patients underwent surgery, and 59 also received the adrenal cytotoxic agent mitotane. The median disease-free interval after surgery was 12.1 months (range, 1 to 175). Tumor dissemination occurred in 82 percent of the patients, most commonly to the lung, liver, and adjacent organs. The median survival time was 14.5 months (range, less than 1 to 175), and the five-year survival was 22 percent. Age over 40 years and the presence of metastases at the time of diagnosis were the only factors recognized as indicating a poor prognosis. Mitotane controlled hormonal secretion in 75 percent of the patients. Eight mitotane-treated patients had partial tumor regression, but the drug did not have a significant effect on survival. We conclude that adrenocortical carcinoma carries a poor prognosis. Mitotane therapy may offer transient benefits, particularly in controlling endocrine symptoms.

Adrenal Cortex Hormones↗
PubMed1990

Ventricular septal defect associated with aortic valve incompetence: results of two surgical managements.

Aortic valve insufficiency with ventricular septal defect is usually treated by plication of the commissures. However, long-term deterioration is common. We propose a new technique that corrects the aortic annulus dilatation and the leaflet prolapse and reinforces the sinus of Valsalva. Two groups were compared: group I (29 patients) had plication of the prolapsed leaflet(s) and folding of the free edge; group II (26 patients) had triangular resection of the prolapse cusp, annuloplasty, and reinforcement of the aortic wall. The two groups were similar with regarding to preoperative clinical data. There was no perioperative mortality. Primary failure (aortic valve replacement) occurred in 8 patients in group I (28%) and in 2 patients in group II (8%). The rate of secondary failure was 31% in group I and 4% in group II. The actuarial rate of freedom from reoperation at 5 years is 55% in group I and 88% in group II (p less than 0.05). The late mortality was 6.5% in group I and 10.9% in group II (no difference). We conclude that aortic valve insufficiency with ventricular septal defect is a malformation of the aortic leaflets, the annulus, and the sinus of Valsalva, and that the proposed technique offers a better result than the usual methods in terms of residual aortic valve insufficiency.

Adolescent↗
PubMed1990

Primary cardiac tumors--French studies of 533 cases.

The present study combining the Eisenman French Joint Study and the Broussais Hospital experience is based upon 533 primary cardiac tumors which were operated on in France and by French-speaking teams during a period of about 25 years. The diagnosis of heart tumors was facilitated by the progressive development of new examination techniques. Echocardiography seems to be the simplest, safest, and the most reliable diagnostic method and is used more frequently then angiocardiography. Cardiac tumors occur at every age with a prevalence for females. About 10% of the surgically treated primary cardiac tumors were malignant (53 patients) with a constantly poor prognosis. The mean survival time of this collective after operation was only 1.5 years. 8% of the benign cardiac tumors were non-myxomatous (36), including fibromas, rhabdomyomas, and hamartomas. The mean age of this group was lower (21 years) than in the collectives with myxomas or with malignant cardiac tumors. Another characteristic of non-myxomatous tumors is the involvement of the ventricles by the neoplasm (88%). Complete resection of the tumor was possible in 75%, only 3 operative deaths occurred. Myxomas are the most common tumors of the heart, representing 83% of all primary cardiac tumors (444). Female patients were involved more often than males. The age of the patients ranged widely from 2.5 to 82 years. The typical localization of the myxomas was the left atrium (83%), followed by the right atrium (11%). In 5 cases myxomas were found multilocalized. Very often myxomas were mimicing valvular disease. In more than 30% peripheral embolization provoked the diagnosis. Only in 2% was the tumor totally asymptomatic.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMed1989

A 10-year comparison of mitral valve replacement with Carpentier-Edwards and Hancock porcine bioprostheses.

Two hundred fifty-three patients who underwent isolated mitral valve replacement with a porcine bioprosthesis had long-term evaluation. One hundred forty-seven patients received a Carpentier-Edwards porcine bioprosthesis and 106, a Hancock valve. There were no significant differences in preoperative clinical characteristics between the two groups. Cumulative follow-up was 1,375 patient-years. At 10 years, 93% +/- 2.5% of the patients in the Carpentier-Edwards group and 85% +/- 7.8% of those in the Hancock group were free from valve-related death (not significant), and 95% +/- 2% and 91% +/- 3.8%, respectively, were free from thromboembolism (not significant). At 10 years, 65% +/- 7.2% of the patients in the Carpentier-Edwards group and 66% +/- 7.2% of those in the Hancock group were free from structural valve deterioration (not significant), and 64% +/- 6% and 59% +/- 7.3%, respectively, were free from reoperation (not significant). We conclude that the first generation of Carpentier-Edwards and Hancock prostheses produce comparable long-term results in the mitral position.

Actuarial Analysis↗
PubMed1988

Clinical comparison of mitral valve replacement using porcine, Starr, and Bjork valves.

The choice of a cardiac prosthesis for mitral valve replacement remains controversial, and thromboembolic complications are still a major cause of morbidity and mortality in patients with mechanical valves. Because of this, permanent anticoagulation with its risks and constraints on daily life is necessary. Bioprostheses, however, are associated with a lower rate of thromboembolic events. Therefore, the need for long-term anticoagulation is minimized. These advantages are counterbalanced by the limited durability of tissue valves. In an effort to give some perspective to this balance, we compared the long-term results of three commonly used mitral valve prostheses. Three hundred patients operated on in the same institution January 1974 to December 1978 form the basis of this evaluation.

Adolescent↗
PubMed1987

Long-term results of low power, long duration laser trabeculoplasty.

We performed argon laser trabeculoplasty using 0.2-second duration on 15 patients with primary open-angle glaucoma. We then retrospectively compared the results to a similar group of 14 patients on whom a duration of 0.1 second was used. Power was titrated to achieve blanching or small bubble formation. All the other treatment variables were kept constant. Before treatment, the two groups did not differ in mean age, visual acuity, intraocular pressure, or number of drugs. After treatment, there was a 7 to 8 mm Hg decrease in intraocular pressure for both groups over a two-year follow-up period. No statistically significant difference between the two groups was observed for intraocular pressure, visual acuity, or drug score at the various follow-up periods. No patient required subsequent filtering surgery.

Evaluation Studies as Topic↗
PubMed1987

Pattern electroretinogram and optic nerve section in pigeons.

We studied the effect of optic nerve section on the pattern electroretinogram (PERG) of 10 pigeons. Base line PERG and flash ERG were measured prior to surgery and then one optic nerve was cut. We measured PERG at various time intervals up to 24 weeks after the section. There was a sharp drop in PERG amplitude immediately following the section. It gradually returned to normal levels in the following 24 weeks. Significant decreases in time to peak were noted at 1 and 16 weeks for 0.5 cycle per degree checks and at 1, 2 and 9 weeks for 0.25 cycle per degree checks. The ERG generated by a TV stimulus did not change in amplitude but had a shorter time to peak at 24 weeks for a high intensity stimulus and at 16, 18, 24 weeks for a low intensity stimulus. Light and electron microscopic sections (at 24 weeks) revealed an almost complete loss of nerve fibers in the optic nerve. Retinal sections revealed only a few surviving ganglion cells and a few nerve fibers. This suggests that in pigeons, PERG is not generated by ganglion cells.

Animals↗