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Biomedical subjects

Pascal Berna

Publications and source records attributed to Pascal Berna.

7 recordsLinked to original sources
PubMed2006

Intrapulmonary lymph node metastasis and renal cell carcinoma.

Intrapulmonary lymph node metastasis occuring after nephrectomy for renal cell carcinoma is a particular recurrence modality. Authors report two male patients presenting with this recurrence 2 and 4 years after treatment of the primary and who underwent surgery. Surgery confirmed the diagnosis and demonstrated station 7 minimal metastases and positive pleural lavage cytology in both patients. The first patient survived 2 years and the second was alive disease free at 33 months follow-up. Such metastases probably originate from the thoracic duct. Resection confirms the diagnosis and may be part of the treatment.

Adult↗
PubMed2006

Prognostic value of histology in resected lung cancer with emphasis on the relevance of the adenocarcinoma subtyping.

BACKGROUND: Adenocarcinoma (AC) is the most common lung cancer, followed by squamous cell carcinoma (SCC). Controversy exists concerning both cell types. Our purpose was to compare their prognosis after resection and determine whether AC subtyping may have any significance. METHODS: From 1993 to 2002, 574 patients with SCC and 565 with AC underwent a curative resection and were compared according to sex, age, type of resection, TNM system classification, and survival. One hundred fifty-nine patients with ACs demonstrated a pure histologic pattern according to the 1999 World Health Organization classification, and 406 were of the mixed subtype including cell types with potentially different aggressiveness. Therefore, we compared subgroups according to presence or not of bronchioloalveolar carcinoma or solid adenocarcinoma with mucin component, or both. RESULTS: Compared with ACs, SCCs had a higher number of males and older patients, and incidences of endobronchial tumors, pneumonectomies, and stage II tumors were higher. Global survival rates were not different. The ACs with solid AC with mucin components (n = 239) were characterized by more males and stage IIB patients, and had poorer survival rates (38.6% vs 61.4%; p < 0.0014) than the ACs without solid AC with mucin component. When comparing these with SCCs, 5-year survival rates were: ACs without solid AC with mucin component (58.1%), SCCs (50.2%), and ACs with solid AC with mucin component (36.8%) (p < 0.000019). Multivariate analysis demonstrated these subgroups and SCCs to be independent factors of prognosis. CONCLUSIONS: Solid ACs with a mucin component demonstrated the poorest prognosis after resection. Further studies of this cell type, which should be looked for carefully, may help improve targetting adjuvant therapies.

Adenocarcinoma↗
PubMed2005

Immediate and long-term survival after surgery for lung cancer in heart transplant recipients.

BACKGROUND: Lung cancer observed after heart transplantation is considered to have a poor prognosis. However, the results of surgical treatment have not yet been significantly evaluated. This retrospective study analyzed the immediate and long-term results after surgery. METHODS: From May 1990 to December 2003, 25 heart transplant recipients underwent surgery for lung cancer. There were 22 men and 3 women, the mean age was 60.7 years (49-72). All patients had a smoking history. Lung tumors were discovered by routine chest roentgenograms and computed tomography scans in 17 patients (68%), because of clinical symptoms in 7 (28%), and incidentally in 1 (4%). The surgical procedures consisted of 23 lobectomies and 2 wedge resections. RESULTS: The mean postoperative hospital stay was 14.2 days (5-34). The morbidity rate was 28% (n = 7 patients). The mortality rate was 12% patients (n = 3 patients). The postoperative complications in 7 of 10 patients were mainly from infectious origin. Five-year survival rate was 40.9% with a median survival of 45 months. Seven patients died during follow-up (3 from cancer and 4 from other diseases). Significant better survival was observed in N0 patients than in N+ patients (median survival of 56.8 months in N0 vs 13.5 months in N+ patients (p = 0.017). CONCLUSIONS: Long-term results after surgery were satisfactory in early stage disease, despite a high risk for postoperative infection. Our results underline the efficiency of a close follow-up for transplant recipients with a smoking history, leading to cancer detection at an early stage.

Aged↗
PubMed2005

Sleeve lobectomy versus pneumonectomy: tumor characteristics and comparative analysis of feasibility and results.

BACKGROUND: Sleeve lobectomy (SL) seems to have better results than pneumonectomy. Some authors propose to extend its indications. The aim of this study was to compare postoperative results, locoregional recurrence, and survival after sleeve lobectomy and pneumonectomy in focusing on right upper lobe cancer. METHODS: From 1984 to 2002, 973 lung resections were performed for T1, T2, and bronchial T3 right upper lobe non-small cell lung cancer. There were 756 lobectomies (L group), 151 pneumonectomies (RP group), and 66 sleeve lobectomies (SL group). The RP group was further divided with regard to intrapulmonary lymph node involvement. Pneumonectomy 1 (RP1) was a group of N0, intralobar N1, and skip metastasis involvement (N0-N2). Pneumonectomy 2 (RP2) was a group of extralobar N1 and nonskip metastasis involvement (N1-N2). Postoperative results were compared among SL, L, and RP groups. Survival was compared between the two homogeneous groups for oncologic characteristics (SL, RP1). RESULTS: Statistical comparison of 5-year actuarial survival showed a significant difference favoring SL (SL: 72.5%/ RP1: 53.2%; p = 0.0025). Postoperative mortality was higher after RP (L: 2.9% / SL: 4.5%/ RP: 12.6 %). Significant factors limiting SL were tumor size, extralobar N1, and main bronchus involvement (p = 0.000026, 0.0002, and 0.005, respectively). CONCLUSIONS: Immediate and long-term survival appears better after sleeve lobectomy than right pneumonectomy for comparable stages of right upper lobe cancer. For frequency to increase by systematic attempt at SL, limited by large tumors and extralobar N1 involvement, the only way should be after favorable response to induction chemotherapy.

Carcinoma, Non-Small-Cell Lung↗
PubMed2005

Pulmonary sequestration and aspergillosis.

OBJECTIVE: Pulmonary sequestration (PS) is an uncommon congenital disease. Symptoms when present are usually secondary to pyogenic infection. Our objective was to draw attention on superimposed fungal infection. METHODS: During the last 20 years, we operated upon 19 intralobar PS. Four of six patients operated during the last decade proved to have intralobar PS containing Aspergillus. RESULTS: In one patient aspergillosis presented as an aspergilloma and communications between the sequestration and small bronchi were present. In another patient diagnosis was made before operation because of positive precipitins test. In two patients aspegillosis was discovered by the pathologist. CONCLUSIONS: Review of literature demonstrates PS fungal colonization to be a rare but recently reported entity (14 cases reported). The observation of four consecutive patients leads us to suggest that PS aspergillosis must be considered in order to evaluate its incidence.

Adult↗