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R Jancovici

Publications and source records attributed to R Jancovici.

At least 55 records · Page 3Linked to original sources
PubMed1996

[Incidents and complications of therapeutic thoracoscopy. Apropos of 898 operated patients].

The exceptional interest in endoscopic surgery, both in laparoscopic surgery and video-assisted thoracoscopic surgery have led many teams to widen their indications. This movement has developed into a revolution in techniques demanded by patients, the public, and the medias, requiring many practicians to use these techniques more and more often and consequently to attempt very delicate operations. This "explosion" of endoscopic techniques has largely benefited from advances in equipment development (optics, video instrumentation) but has also required that operators acquire rigorous procedures for the proposed techniques. With the development of new thoracoscopic techniques for therapeutic indications, there are an unavoidable number of incidents and complications. These incidents and complications are related both to the use of instruments undoubtedly not well enough adapted to the procedures used and also to "forced" indications. We humbly recognize that a certain number of incidents are related to the necessarily inadequate experience of the operators during the "run in" period. We emphasize that video-assisted thoracoscopic surgery is a complementary technique among the available therapeutic armamentarium. We evaluated the mid and long term results of cancerology exeresis with these two techniques and underscore that morbidity and complications are rare but sometimes unacceptable. In conclusion, whatever the form of the technique used, it is an important evolution in surgery which must abide by the classical rules, in particular for indications in cancer surgery.

Endoscopy↗
PubMed1996

[Tumor of the peripheral nerve sheath with rhabdomyoblastic differentiation arising in a ganglioneuroma: neurilemmoma? A fortuitously detected case].

An otherwise healthy 21-year-old man with no evidence or family history of Von Recklinghausen's neurofibromatosis presented a posterior mediastinal mass detected on routine chest radiographs. The findings of standard light microscopy, ultrastructural examination and immunohistochemical studies suggested the working hypothesis of an unusual malignant "Triton" tumour: -arising in a pre-existing de novo ganglioneuroma; -fortuitously detected; -predominantly made of multinucleated spindle cells with only ultrastructural and immunohistochemical rhabdomyoblastic differentiation.

Adult↗
PubMed1995

Videothoracoscopic excision of thoracic neurogenic tumors.

BACKGROUND: Videothoracoscopic surgery is a new procedure for treating neurogenic tumors of the thorax. Feasibility and utility of this technique are not yet well defined. METHODS: Over a 26-month period, 26 neurogenic tumors of the thorax were treated in five general thoracic surgery centers performing videothoracoscopic surgery. Indications and contraindications for this new procedure and initial results were retrospectively studied. RESULTS: Contraindications to videothoracoscopy included intraspinal extension of the tumor (n = 3), spinal artery involvement (n = 2), tumors more than 6 cm in diameter borderline located within the thorax (n = 2), and middle mediastinal location (n = 1). Videothoracoscopy was performed in 18 patients. Conversion to thoracotomy was required in 3. In 1 patients, subsequent chest wall resection was performed because of malignancy. Postoperative hospital stay was uneventful. It was shorter after videothoracoscopy. Postsurgical pain was more acute in patients who had thoracotomy or conversion to thoracotomy. CONCLUSIONS: Videothorascopy is a good alternative for managing neurogenic tumors of the thorax when deemed feasible. There is a tendency toward a shorter hospital stay with less pain in patients treated by this new procedure.

Adolescent↗
PubMed1995

[Round pulmonary lesions after returning from French Guyana. Six cases of american pulmonary histoplasmosis].

From 1989 to 1994, 71 patients were hospitalized for diagnosis of round lung lesions including 49 servicemen under the age of 45 years who had been stationed in tropical areas. In 6 of these servicemen, the diagnosis was pulmonary histoplasmosis at the tertiary stage of histoplasmoma. All had done duty in French Guyana and were negative for human immunodeficiency virus. The subpleural lung opacity was the only lesion in 5 out of 6 patients and was calcified in 4 out of 6 patients. Since skin tests with histoplasmin and serologic testing for histoplasmosis failed to achieve definitive diagnosis, surgical biopsy was performed by conventional thoracotomy in 2 cases and video-assisted thoracic surgery in 4 cases. The specimens obtained confirmed diagnosis of histoplasmosis on mycologic criteria in 3 cases and on a combination of findings including compatible histologic evidence in 3 cases. Treatment consisted in surgical excision of the nodules, for which video-assisted thoracoscopic surgery proved to be an excellent technique because of its simplicity and rapidity.

Adult↗
PubMed1995

[Ossified bronchial neuroendocrine tumors: 3 cases].

Large calcium deposits can occur in neuroendocrine tumours of the bronchi and have been observed more frequently with the development of tomodensitometry which is now used for the diagnosis of calcified lung tumours including neuroendocrine tumours. The knowledge of such calcified images should not however mask the possibility of a malignant tumour.

Adult↗
PubMed1995

[Malignant triton tumor of the posterior mediastinum treated by thoracoscopic approach. Apropos of a case].

A tumour of the posterior mediastinum was removed via thoracoscopy. The histology report was a triton tumour. This is a rare (less than 80 cases reported in the literature) malignant tumour of the nervous system: malignant schwannoma with rhabdomyoblastic differentiation. The characteristics of this rare tumour and the consequences of videoassisted surgery in this specific case are discussed: a second access is required to widen the thoracotomy and complementary radiotherapy is needed.

Adult↗
PubMed1994

[Operative risk in thoracic surgery].

Operative risk is encountered daily in thoracic surgery. Preoperatively, the risk can be evaluated by the pneumologist as well as the intensive care-surgery team. The parenchymal function and the patients respiratory capacity during the post-operative period should be evaluated. It is fundamental to evaluate heart function and vascular capacity. We discuss operative risk of dissection. The risk of bronchial fistulization is estimated at 5% (pneumonectomy) and 1% (lobectomy). Immediate complications include air leaks, rhythm disorders and post-operative bleeding. Thoracic drainage is a determining factor in thoracic surgery. The main problem remains post-operative respiratory failure especially since carcinological exeresis is usually carried out in patients with bronchopathies.

Humans↗
PubMed1994

[Video-assisted thoracoscopic surgery].

Since the team at the Laennec hospital first performed an extra-pleural thoracoscopy in 1990, a certain number of thoracic surgery units have started using this new technique. Video-assisted thoracoscopy is an absolutely revolutionary technique allowing an intrapleural approach to the mediastinum and to the pulmonary parenchyma without a thoracotomy. It requires a sophisticated technical set up including a video camera, direct or angular optics, and a video screen. The patient is placed in the same position as for a thoracotomy. For the pneumothorax and dystropic bullae, Video assisted thoracoscopic surgery has been largely shown to be the superior technique. The pleura is treated by avivement or sometimes by pleurectomy. Pulmonary biopsies are often taken. Preoperative computed tomography with methylene blue injection is often required for the exeresis of peripheral parenchymatous sub-pleural nodules and sometimes a small fishhook has to be placed within the tumour. Inversely, segmentectomies or lobectomies are rarely performed. There is a certain amount of risk involved in closed chest vascular dissections, and the question of carcinologic rigour has to be raised. Tumours of the mediastinum, both cystic and solid tumours, are relatively easy to approach by dissection using video assisted thoracoscopy. Finally, this technique offers new possibilities for staging bronchial cancers, the treatment of broncho-pleural fistulas, and more recently for non operated chest trauma. This new technique is of great importance for the thoracic surgeon, although an evaluation of long-term results are still required.

Biopsy↗
PubMed1993

[Inflammatory pseudo-tumor of the lung. Clinico-pathologic report of a case].

One case of a solitary pulmonary nodule occurring in a 54-year-old woman with history of breast carcinoma is presented. Histological examination of the surgical specimen excluded breast carcinoma metastasis and revealed an inflammatory pseudotumor. Principal clinico-pathological findings in previously reported cases are described. Inflammatory pseudotumors may exhibit, as in our case, some nuclear atypia making the diagnosis sometimes difficult with malignancy.

Breast Neoplasms↗
PubMed1992

[Malignant primary intrathoracic histiocytofibroma].

Malignant primary intrathoracic fibrous histiocytoma (MFH) is a rare tumour: since it was first described in 1979, hardly more than 80 cases have been published. We present a large MFH which had started in the pleura and was intrathoracic. The tumour was typical, being comprised of malignant fibroblastic and histiocytoid cells in storiform arrangement. It was revealed by spinal bone metastases which multiplied over the whole skeleton in spite of chemotherapy. The patient died of cerebral metastasis developed 8 months after the onset of the disease. The cases found in the literature are gathered together and commented.

Bone Neoplasms↗
PubMed1990

[Value of investigation tests in thoracic goiters].

Two groups of substernal goiters should be considered fist; the "simples" ones localised in the anterior and superior part of the mediastin. They are most common and less dangerous. By opposition to the "complexes" ones which have relation with the vessels, the airways and the digestive tube. That surgeons would like to approach with security. The study of those retrosternal goiters requires two categories of complementary examinations. One for diagnosis: X Ray standard of the neck and the chest; Echography Biopsy and Radioactive Iodine scintigraphy. Others for localisations to prevent the risks, particularly vascular seeing in the surgery of the substernal goiters: TDM and IRM.

Biopsy, Needle↗
PubMed1990

[Ewing's sarcoma and peripheral neuroectodermal tumors. Report of a case with laterothoracic localization].

The authors report the case of a 20-year old male patient presenting with a lateral thoracic tumour which at pathological examination looked like an extra-osseous Ewing's sarcoma. Strongly positive NSE immunolabeling suggested a recently described variant of this lesion: Askin's tumour. In 1979, F. B. Askin described a tumour made of round small cells, located on the side of the thorax and possibly derived from differentiated neuroectodermal tissue. Since that time, the ever wider use of electron microscopy and immunohistochemical methods has made it possible to demonstrate the existence of peripheral neuroectodermal tumours (PNETs) distinct from neuroblastomas. Askin's tumour being only, as it turned out, one of their clinical forms. Following a brief presentation of the clinical, pathological and therapeutic features of PNETs, the authors underline the great similarity between these tumours and Ewing's sarcoma. Owing to the successive discoveries of a cytogenetic abnormality common to these tumour--t(11;22)(q24;q12)--, of a similar expression of proto-oncogens and of identical neuroenzymatic characteristics, Ewing's syndrome can now be regarded as the most undifferentiated of all PNETs, probably arising from the postganglionic neuron of the parasympathetic system.

Adult↗