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Biomedical subjects

R Mégevand

Publications and source records attributed to R Mégevand.

At least 19 recordsLinked to original sources
PubMed1997

[Surgical resection of primary lung cancer. A 13-year experience in Geneva].

This retrospective study concerns 683 consecutive patients operated for primary non-small cell lung cancer between 1977 and 1989 (581 men and 102 women with a mean age of 60.3 years). Histology was as follows: squamous in 422 (62%), adenocarcinoma in 207 (30%), broncho-alveolar in 24 (4%) and large-cell in 30 (4%). According to the TNM classification, 304 tumors were graded as stage I (45%), 130 as stage II (19%), 157 as stage IIIA (23%), 62 as stage IIIB (9%) and 19 as stage IV (3%). Surgery consisted of lobectomies in 337 (49%), pneumonectomies in 210 (31%), segmentectomies and wedge resections in 42 (6%), bilobectomies in 41 (6%) and exploratory thoracotomies in 53 (8%). It was curative in 513 cases (75%) and palliative in 170 (25%). 49 patients died within 2 months of the operation (7.2%), while 209 suffered postoperative complications (31%). Mediastinal lymph node dissection was not routinely performed to in this series. However global outcome (30% 5 years survival and 18% at 10 years), compared favorably with that reported by centres that perform mediastinal lymphadenectomy systematically.

Actuarial Analysis↗
PubMed1993

Traumatic paramediastinal air cyst: report of two cases and review of the literature.

Two cases of traumatic paramediastinal air cyst are presented with a review of the literature. This rare condition affects young people and usually occurs on the left side of the chest. Its course is spontaneously benign. Although they are usually easily diagnosed on chest roentgenograms, these cysts may sometimes be difficult to differentiate from other more serious traumatic lesions. Computed tomography (or a contrast swallow roentgenogram in some instances) can elucidate doubtful cases.

Adult↗
PubMed1992

Predictability of FEV1 after pulmonary resection for bronchogenic carcinoma.

The aim of this study was to review the reliability of prediction of postoperative FEV1 in patients with bronchogenic carcinoma using a Tc-99m perfusion scan and simple spirometry. Over a 27-month period, 40 patients without known recurrent disease had their FEV1 measured. One quarter of the postoperative values for FEV1 differed from predicted values by less than 5% (2/11 pneumonectomies, 5/23 lobectomies, 3/6 segmental resections) and half differed by no more than 10% of predicted FEV1 (4/11 pneumonectomies, 12/23 lobectomies, 3/6 segmentectomies). One tenth of the predicted values differed by more than 30% and up to 760 mls (1/11 pneumonectomies, 2/23 lobectomies, 1/6 segmentectomy). Disease recurrence, phrenic nerve paralysis, exacerbation of obstructive pulmonary disease and poor collaboration during spirometry explained the most severe erroneous results. Age, preoperative smoking, tumour stage and histology, absence of symptoms at the time of diagnosis and adjuvant radiotherapy showed no statistically significant effect on predictability. Twenty-one patients had a postoperative Tc-99m pulmonary scan simultaneous to the spirometric control. Overestimation of postoperative FEV1 was associated with heterogeneous distribution of ventilation and perfusion.

Adenocarcinoma↗
PubMed1992

Leiomyosarcoma of the pulmonary hilar vessels.

Leiomyosarcomas are uncommon tumors. They have a predilection for deep soft tissues, with a rare group arising in medium-sized or large veins, far less frequently in arteries. We report a case of a 63-year-old man, with an enlarging mass located in the left pulmonary hilar region which was discovered on a routine chest radiograph. Cytology of the sputum and bronchoscopic biopsies did not reveal any malignant cells. Over 5 months observation, there was a clear progression of the mass, and the patient finally underwent a left pneumonectomy which allowed the diagnosis of an intravascular leiomyosarcoma partially destroying major arteries and veins in the hilar region. A review of the literature reveals 67 cases of leiomyosarcoma involving the pulmonary artery. None of these cases had an associated venous pathology. The disease is found mainly in adult women. Clinical diagnosis is very difficult because most of the cases have no specific clinical signs; the major differential diagnosis is that of pulmonary thrombo-embolism. Prognosis depends on histological degree of the tumor and extent of the disease, metastases occur mainly in the liver, lung, and brain and less frequently in regional lymph nodes. Treatment is always surgical, chemotherapy is ineffective and the effectiveness of radiotherapy depends on the total dose of irradiation. Sarcomas of hilar blood vessels have a very poor prognosis with a one year survival estimated, from the onset of symptoms, at 20%.

Humans↗
PubMed1992

[Asymptomatic mediastinal masses: prognosis, attitude and impact of thoracic radiography].

Mediastinal masses remain an interesting diagnostic and therapeutic problem for the clinician. Recent advances in imaging techniques and the increased use of chest roentgenograms in medical practice contribute to early screening of asymptomatic mediastinal masses. From 1965 to 1990, 290 patients with a primary mediastinal cyst or neoplasm were operated and treated in our institution. Among those, 80 patients presented with asymptomatic mediastinal masses. The prognosis of these asymptomatic lesions was evaluated and compared to that of symptomatic ones. Overall, two third of patients who were asymptomatic at diagnosis had a neoplasm, which proved to be malignant in half of the cases. A significantly greater number of patients with malignant neoplasms were asymptomatic at the time of diagnosis during the recent period. The prognosis of these asymptomatic lesions appeared to be better in selected tumoral types (e.g. thymomas, lymphomas) although it was difficult to completely avoid statistical bias. Early radiological detection of mediastinal tumors could improve their prognosis in selected cases. Incidental diagnosis of mediastinal masses by radiological examination should lead to early aggressive diagnostic procedure and treatment.

Adolescent↗
PubMed1992

[Impact of organ shortage on the transplantation program].

The purpose of the study was to evaluate the consequences of a recent progressive shortage of donor organs on our different transplant programs. Although the waiting time before transplantation remained in general relatively short (4.6 [mean], 0-3, 0-10 months for renal, liver and heart transplantation, respectively), patients started to accumulate on our waiting list during the last year (1990) of the study (kidney transplantation). Furthermore some patients clearly deteriorated, other died awaiting transplantation (18% and 15% of the patients listed for liver and heart transplantation, respectively). In emergency, organs were provided most often by neighbouring foreign centers. Given these facts adhesion to supranational donor networks should be considered.

Humans↗
PubMed1992

[Kidney retransplantation: results and prognostic factors].

48 non primary renal transplants were performed in 40 recipients during the 1973-1990 period in our institution (40 second grafts, 6 third grafts and 1 four and fifth grafts). Despite poor HLA matching our second graft survival rates compare favorably with others (80% and 70%, 1 and 5 year graft survival rates). The type of immunosuppression (including ciclosporine A or not) and the duration of the first graft had an influence on the outcome of second grafts. Our experience with repeated retransplantation is limited, but graft survival appears to be poor: most of the grafts were rejected within 2 years (or less). However patient survival was not affected by overimmunosuppression following multiple grafts.

Adolescent↗
PubMed1991

[Multinodular pulmonary type AL amyloidosis. Report of a case and review of the literature].

A multinodular lung lesion was discovered in a healthy 56 year-old man on routine chest X-rays. Histology revealed multinodular amyloidosis which histochemically was found to correspond to the AL type. This type of amyloidosis raises the differential diagnosis ith a lung neoplasm. In our case, no cell dyscrasia was observed. The patient was treated by surgery as recommended in the literature.

Aged↗
PubMed1991

[Urologic complications of kidney transplants. Geneva cases, 1981-1990--observations on 200 transplantations].

Between 1981 and 1990, 200 kidney transplantations were performed at the Cantonal Hospital of Geneva. Overall, 11% of patients developed a urological complication in this series. Of these complications, 40.9% were ureteral stenosis, 22.7% urinary leakages, 13.6% infected vesico-ureteral reflux, 13.6% genitourinary tumors and 9.2% other urological complications. The authors compare their series with the literature.

Humans↗
PubMed1991

[Incidence of primary mediastinal lesions: change in the profile and therapeutic implications].

The pattern of occurrence of mediastinal masses has to be taken into account when treating and approaching these lesions. In most reported series tumors of neural or germinal origin and thymomas are predominant. We reviewed the records of 277 patients operated for primary mediastinal lesions over the last 25 years (1965-1989) in our center. Surprisingly (Hodgkin's and non-Hodgkin's) lymphomas (24-25%) were found to emerge as the most common tumors in our series, whereas tumor of neural (11%) and germinal (65%) origins were relatively rare and decreasing in incidence. Thymomas (17%) and mediastinal cysts (14%) occurred as predicted in the literature. Consequently the malignancy rate was high (53%) even in asymptomatic patients (18%). Similar findings have been described recently by others. Factors responsible for this new distribution are difficult to identify. The therapeutic implications of the changes are discussed.

Adolescent↗
PubMed1991

[Multiple metachronous lung tumors. Metastases or second primary tumor].

The first description of multiple primary tumors of the lung was reported by Billroth in 1889. In a series of 448 thoracotomies for lung cancer in the Department of Thoracic Surgery of the Geneva Cantonal University Hospital, 11 were performed in 9 men and 2 women for double metachronous lung tumors. The tumor-free time interval between the operations ranged from 9 months to 15 years, with a mean of 61 months. The tumor was in the contralateral lung in 4 patients and in the ipsilateral one in 7 cases. Pathological examination demonstrated a different histology in 4 patients (36%). Eight of the 11 patients had resectable disease. Twenty-five percent of the patients survived without recurrence for 5 years. Four patients (36%) died within one year of diagnosis of the second tumor; three of these patients did not have a resectable second tumor. The risk of development of a second primary lung carcinoma is low, less than 1-2.1% in some series, 2.7% in our series. The survival is fairly similar to that of primary lung carcinomas in general. Surgery offers the best treatment for these tumors, which is why resection of lung carcinomas should be as limited as possible. Long-term follow-up for more than 5 years and suppression of carcinogenic factors are therefore justified.

Adenocarcinoma↗
PubMed1990

[Epidermoid cancer of the esophagus: overview].

Numerous extrinsic factors are involved in the pathogenesis of esophageal cancer. The disease exhibits clinical symptoms only at the advanced stage, often when no further curative possibilities exist; this delay is one of the main causes of the poor prognosis still associated with esophageal cancer. To secure early diagnosis, contrast GI series and endoscopy should be performed immediately whenever esophageal symptoms are present. Initial assessment of esophageal cancer should in any case include thoraco-abdominal scan. Bronchoscopy is indicated when the tumor is localized in the middle third of the organ. Surgery has long been considered the only valid treatment for esophageal cancer. However, the rule today is a multidisciplinary approach which offers either curative or palliative treatment designed to optimize therapy and minimize side effects. Promising results have recently been obtained with a combination of radiotherapy-chemotherapy followed by esophagectomy.

Bronchoscopy↗
PubMed1990

[Cervico-thoracic outlet compression syndrome].

This retrospective study compares the results of two surgical procedures, a transaxillary and a transthoracic (i.e. antero-lateral thoracotomy) approach, in the treatment of the thoracic outlet syndrome by first rib resection. Following transaxillary first rib removal (13 cases), initially our procedure of choice, 84% of patients had symptoms improved, 8% were unchanged and 8% were worse after one year. One permanent, disabling brachial plexus injury occurred after this operation. Transthoracic first rib resection (18 cases), presently our preferred technique, resulted in improvement in 87% of cases, with 13% of symptoms unchanged after one year. While two female patients felt mild paresthesia of their mammary gland, no one has been made worse following this route. These two approaches have achieved similar results in the surgical management of this syndrome. Nevertheless, when first rib resection is indicated, our favored and recommended procedure is the transthoracic one, as this appears less hazardous for brachial plexus damage.

Axilla↗
PubMed1990

[Pulmonary aspergilloma].

Pulmonary aspergillomas usually arise from colonization of Aspergillus in preexisting lung cavities. Between 1972 and 1988, 18 patients underwent thoracotomy for treatment of pulmonary aspergilloma in our institution. Eight patients had simple aspergilloma and ten had complex aspergilloma. Hemoptysis was the most frequent complication. Tuberculosis was the most common underlying lung disease. Patients presenting with complex aspergilloma usually had associated factors potentially reducing their immune competence. Patients with simple aspergilloma tolerated surgery quite well and the outcome was satisfactory. By contrast operative mortality was 30% (3 deaths) in patients with complex aspergilloma and complications occurred in 8 patients (80%). Treatment of pulmonary aspergilloma must be individualized to take into account the patient's overall health and the risks attendant with each treatment modality.

Adult↗
PubMed1989

[Neo-adjuvant radio-chemotherapy of epidermoid carcinoma of the esophagus].

In spite of progress in surgery and radiation therapy, esophageal squamous cell carcinoma's outlook remains grim with a cure rate of approximately 10%. The high failure rate is not only due to loco-regional failure but also to distant metastasis. The association of preoperative chemotherapy with radiation has gained interest with hope to improve control of this disease. The present pilot study is an alternating treatment of chemotherapy and radiotherapy for poor risk carcinomas of the esophagus, not primarily amenable to surgery. The chemotherapy is composed of Cis-Platinum 60 mg/m2 Day 1 (D), Mitomycin 8 mg/m2 D1 and Vindesin 3 mg/m2 D1 and D8, alternating with radiotherapy twice 20 Gy in fraction of 2 Gy per day. After reevaluation patients are if possible submitted to surgery and if not, to a third course of treatment to a total of 3 courses and 60 Gy. Seventeen patients were entered in our study with 15 evaluable. The radiochemotherapeutic association was overall well tolerated with no toxic deaths due to treatment. Seven patients had symptomatic improvement after the first treatment cycle. The presurgical evaluation showed 8 CR and 3 PR. Eight patients have been operated with 3 pathological CR and 3 PR. Five patients completed the 3 courses of chemo- and radiotherapy (without surgery) with no improvement compared to the workup before the third course. The survival is as follows: among the 8 operated: 4 are alive without evidence of disease and 4 are dead with 2 postoperative deaths and 1 local recurrence.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1989

[Surgical treatment of pulmonary metastases].

From 1973 to 1988, 58 patients underwent operation for pulmonary metastases in our institution. The operative mortality was low (1-2%). The primary tumor was a melanoma in 7 cases, a sarcoma in 7 cases and a carcinoma in the remaining 44 cases. The overall 5-year patients survival was 30% and compares favorably with other series. Radical surgical excision significantly affects survival. Repeated or bilateral surgical excisions are sometimes needed. With the increased effectiveness of chemotherapy the role of surgery is changing. Surgical treatment of pulmonary metastases is indicated in selected cases.

Adult↗
PubMed1989

[Exploratory thoracotomies for unresectable lung cancer].

We analysed 55 exploratory thoracotomies undertaken in the Thoracic Surgery Service of the Geneva University Hospital between 1977 and 1987, to determine the preoperative examinations to prevent exploratory thoracotomy, a gesture that brings no benefits at all for the patients. We concluded that the most helpful preoperative examination is the CT-scan.

Adult↗