[Atypical lung resection under thoracoscopy].
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Biomedical subjects
P Matet
Publications and source records attributed to P Matet.
[Substernal goiters. 218 operated cases].
The authors are presenting a retrospective study on 218 retrosternal goiters operated between 1968 and 1991. 33% of the goiters were incidentally discovered on a plain X-ray of the chest. Symptoms of compression were present in 50.5% of patients and hyperthyroidism in 16.5%. Respiratory manifestations were more frequent and more severe in patients aged 70 and more. Moreover 90% of those old patients were symptomatic. Goiters migrated anteriorly in 57.7% of cases, posteriorly in 33.9%, both anteriorly and posteriorly in 5.5%. Type of migration was unknown in 2.5%. 3.7% were malignant. 27 patients with respiratory symptoms received corticosteroids to reduce the airway compression. Among 52 patients with hyperthyroidism, 36 were given antithyroid drugs. Among them, some received corticosteroid drugs in order to reduce risks of mediastinal compression. A simple cervicotomy was adequate in 92.7% of case and was completed by sternotomy in 7.3%. The operation was iterative for relapsing or forgotten thoracic goiters in 24 cases. Morbidity was slight even for sternotomized patients. Mortality was noted in 2 cases (0.9%) one of them operated on for poorly-differentiated and suffocating carcinoma of the thyroid. We advise a straightforward surgical attitude as a result of the slight morbidity and mortality, even in sternotomized patients in order to avoid severe compressive complications of the airways.
Adult↗
[Endothoracic goiter operated on by cervicosternotomy. Apropos of 18 cases].
From 1968 to 1992, 18 sternotomies were performed on a total amount of 225 operated substernal goiters (8% of cases). These operations concerned 14 females and 4 males aged of about 67.8 years. 7 patients had already been operated of a goiter within 1 to 50 years. The substernal goiter was discovered on a systematic x ray chest 5 times, and a x-ray scanner once, also clinical symptoms were still present with compressive troubles in 16 times (particularly acute dyspnea 3 times). The sternotomy was always total. It was only required if the operative problems were important at the time of the cervicotomy. Indications for sternotomy were:--impossibility to extraction due to the volume of the goiter 10 times, (including 5 recurrent goiters), independent retrosternal goiter without cervical connexion, 2 times (including 2 recurrent goiters), hemorrhagic linkage, 3 times, invasive cancer, 3 times. Excluding the 3 invasive cancers, the mortality was inexistant and the morbidity very low, especially without respiratory problems. Post operative complications were 2 definitive hypoparathyroidism and 1 regressive recurrential palsy (plus 2 recurrential palsy still present before the operation). The authors pointed out the good tolerance of the sternotomy which, in special case, should be absolutely preferable the cervicotomy alone, in order to reduce the operative risks, especially hemorrhagic and nervous.
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