204 results on '"C, Peillon"'
Search Results
52. [Celiosurgery: beware of antimist sprays! A new septic risk]
- Author
-
C, Peillon, N, Roullée, and J, Testart
- Subjects
Aerosols ,Cholecystectomy, Laparoscopic ,Risk Factors ,Humans ,Pseudomonas Infections ,Bacterial Infections ,Surgical Instruments - Published
- 1992
53. [Acute thrombosis of the right renal vein. Two cases with coagulopathies]
- Author
-
H, Levesque, J, Testart, C, Peillon, J, Watelet, J Y, Borg, H, Papion, and N, Saour
- Subjects
Male ,Heparin ,Thrombosis ,Syndrome ,Blood Coagulation Disorders ,Middle Aged ,Combined Modality Therapy ,Epoprostenol ,Thrombocytopenia ,Renal Veins ,Thromboplastin ,Acute Disease ,Humans ,Female ,Phospholipids ,Autoantibodies - Abstract
We report two cases of renal vein thrombosis, unusual because of acute expression, right renal vein localization, absence of the usual renal or perirenal causes, surgical management and a never before reported etiology. In one case the thrombosis was secondary to primary antiphospholipid syndrome, in the other it was secondary to heparin associated thrombocythemia. In this case surgical management was performed during prostacyclin infusion.
- Published
- 1992
54. [Cholecystectomy by celioscopy. Experience in two Upper Normandy hospital units. Apropos of 178 procedures]
- Author
-
C, Peillon, B, Bokobza, N, Roullee, M, Imbert, L, Lagriffoul, J R, Tubiana, C, Leturgie, and J, Testart
- Subjects
Adult ,Aged, 80 and over ,Male ,Adolescent ,Middle Aged ,Postoperative Complications ,Cholelithiasis ,Cholecystitis ,Humans ,Cholecystectomy ,Female ,Endoscopy, Digestive System ,France ,Prospective Studies ,Hospital Units ,Aged - Abstract
Laparoscopic cholecystectomy (LC) emerges as an effective alternative to classical cholecystectomy, but its safety, benefits and indications still need to be clarified. From September 1989 to March 1991, 178 LC were performed by 8 surgeons in 2 hospitals, on 142 women and 36 men with a mean age of 48.2 years. The gall bladder wall was thin in 160 cases and thick in 18 cases (with 6 cases acute cholecystitis). We observed no deaths, 147 simple procedures with a hospital stay and drug requirement lower than with the usual cholecystectomy via laparotomy. But in 21 cases, the procedure needed a laparotomy, and in 10 cases complications occurred, requiring laparotomy in 6 cases. Our results suggest: a) LC is an improvement in the treatment of uncomplicated gallstones; b) a trained surgeon and extreme caution are required in complicated cholelithiasis; c) classical cholecystectomy is still useful in many circumstances.
- Published
- 1992
55. Could recurrent cholangitis after Roux-en-Y hepaticojejunostomy be explained by motor intestinal anomalies? A manometric study
- Author
-
P, Ducrotte, C, Peillon, F, Guillemot, J, Testart, and P, Denis
- Subjects
Male ,Jejunum ,Cholangitis ,Manometry ,Recurrence ,Jejunostomy ,Humans ,Anastomosis, Roux-en-Y ,Female ,Bile Ducts ,Middle Aged ,Gastrointestinal Motility - Abstract
The aim of this study was to describe the motor patterns found in two patients with recurrent cholangitis episodes after Roux-en-Y hepaticojejunostomy. In one patient, cholangitis was due to a stenosis of the anastomosis between the limb and the left intrahepatic bile duct, while motility of the limb, duodenum, and distal jejunum was normal. In the second patient, no anatomical explanation was found for cholangitis attacks. However, although the duodenal motor activity was normal, the motility of the limb and of the jejunum below the jejunojejunal anastomosis was grossly abnormal: permanent minute rhythm, phase IIIs absent or rare and slowly propagated, all motor abnormalities that could promote bacterial overgrowth in the limb. This stresses the interest in performing motor studies of the Roux-limb when cholangitis remains unexplained after Roux-en-Y hepaticojejunostomy.
- Published
- 1991
56. [Surgical thoracoscopy]
- Author
-
C, Peillon and J, Testart
- Subjects
Thoracoscopy ,Humans ,Pneumothorax ,Thoracic Surgery ,Sympathectomy ,Pneumonolysis - Abstract
Surgical thoracoscopy is performed with laparoscopic material and instrumentation and is not limited to the therapeutic applications of classical pleuroscopy such as thoracic sympathectomy or pleurectomy for pneumothorax. It is a simpler, more rapid technique which causes less tissue damage and appears to be more effective than the other transparietal techniques. It has been performed twice for sympathectomy and five times for recurrent pneumothorax with excellent results.
- Published
- 1991
57. Endoscopic injection of adrenaline for severe peptic ulcer haemorrhage in high surgical risk patients
- Author
-
E. Lerebours, C. Peillon, B. Parent, C. Guedon, R. Colin, Duhamel C, and P Ducrotte
- Subjects
medicine.medical_specialty ,Blood transfusion ,Epinephrine ,medicine.medical_treatment ,Injections, Intralesional ,Critical Care and Intensive Care Medicine ,Endoscopy, Gastrointestinal ,Risk Factors ,Anesthesiology ,medicine ,Humans ,High surgical risk ,Stomach Ulcer ,Aged ,Aged, 80 and over ,Chemotherapy ,medicine.diagnostic_test ,business.industry ,medicine.disease ,Endoscopy ,Surgery ,Peptic Ulcer Hemorrhage ,Anesthesia ,Peptic ulcer ,Duodenal Ulcer ,Complication ,business ,medicine.drug - Abstract
Endoscopic adrenaline-hypertonic injection was attempted in 40 patients admitted for oesophagogastroduodenal ulcer haemorrhage unresponsive to conventional medical treatment and presenting with severe underlying disease or advanced age (less than 80 years). The results were compared with our own historical controls (43 patients) treated by conventional therapy, meeting the same inclusion criteria. Permanent haemostasis was achieved in 32 patients in the injection group and 30 in the control group (NS) but emergency surgery was less frequent in the injection group (2 vs 25, p less than 0.001). Blood transfusion requirements were less in the injection group (8.5 +/- 6.2 vs 10.2 +/- 5.4, p less than 0.05) but length of hospital stay was not really different (15.7 days +/- 9.3 vs 20.9 +/- 14.4). Unfortunately, mortality was not reduced in the injection group (14/40 vs 17/43). Two lethal complications attributable to injection treatment occurred. This treatment could represent an alternative to conventional haemostatic treatment in high surgical risk patients with severe clinical bleeding, avoiding emergency surgery. In spite of the fact that we selected high-risk patients, endoscopic treatment was not able to lower the mortality (about 37%). Due to severe unpredictable side effects and potential risks of long-term massive rebleeding, this treatment should be performed electively in patients with severe clinical bleeding, as first line treatment when surgical risk factors exist or immediately before surgery in low risk patients.
- Published
- 1991
58. [Leiomyosarcoma of the inferior vena cava. Report of 3 cases]
- Author
-
T, Delaunay, C, Peillon, F, Duparc, R, Koenig, J M, Muller, J F, Deotto, J, Watelet, and J, Testart
- Subjects
Leiomyosarcoma ,Male ,Echinococcosis, Hepatic ,Liver Neoplasms ,Humans ,Female ,Vena Cava, Inferior ,Phlebography ,Middle Aged ,Tomography, X-Ray Computed - Abstract
Three cases of leiomyosarcoma of the inferior vena cava are reported. With the help of a review of the literature, the value of ultrasonography, computed tomography and cavography is recalled. Surgical possibilities and results are described together with the necessity of adjuvant treatments.
- Published
- 1991
59. [Collis's operation for brachyesophagus. (49 patients)]
- Author
-
J, Testart, A, Kartheuser, C, Peillon, J P, Galmiche, and P, Denis
- Subjects
Adult ,Male ,Adolescent ,Gastroplasty ,Hydrogen-Ion Concentration ,Middle Aged ,Endoscopy, Gastrointestinal ,Barrett Esophagus ,Postoperative Complications ,Recurrence ,Esophagoplasty ,Gastroesophageal Reflux ,Humans ,Female ,Prospective Studies ,Aged ,Follow-Up Studies - Abstract
The results of infradiaphragmatic Collis' gastroplasty for the treatment of gastroesophageal reflux associated with acquired short brachyesophagus (Barrett's esophagus) were prospectively studied in 49 patients (50 operations). Clinical and endoscopic findings, and 3-hour postprandial pH measurement including Kaye's score were evaluated at short (3 to 8 months), medium (1 to 4 years), and long-term (more than 4 years) for all patients. Postoperative morbidity was 16 percent; there were 3 deaths (6 percent). Short term results, evaluated in 45 patients, were considered satisfactory in 30, poor (pyrosis and esophagitis) in 2, and incomplete (pyrosis without esophagitis in 2, dysphagia in 5, mild esophagitis in 6) in 13. Long term results (32 patients) were satisfactory in 24, poor in 5, and incomplete in 3 (pyrosis without esophagitis in one, gastric outlet disorder in 2). Long term pH measurements were obtained in 21 patients: 3 out of 6 patients with high scores had clinical or endoscopic signs of esophagitis. Analysis of late results showed that: a) satisfactory short term outcome was maintained in all but 2 patients (deterioration was observed in one patient 4 years later because of aggressive treatment for terminal bronchopulmonary carcinoma; the other was observed 5 years later after steroid therapy for aspergilloma with severe asthma); b) pH scores were variable in 11 patients. This variability and discordance of pH measurements was most likely due to the presence of acid secretion above the new esogastric junction, which was observed in half of the cases. We conclude that Collis' gastroplasty provided good results in Barrett's esophagus and might be compared to duodenal diversion in ulterior studies in this setting.
- Published
- 1991
60. Marteau, vous avez dit marteau?
- Author
-
H. Levesque, Isabelle Marie, Nicole Cailleux, H. Courtois, and C. Peillon
- Subjects
medicine.medical_specialty ,business.industry ,Vascular disease ,Arterial disease ,Gastroenterology ,medicine.disease ,Surgery ,Aneurysm ,medicine.artery ,Internal Medicine ,Medicine ,business ,Complication ,Ulnar artery - Published
- 1999
61. [Repeated subinguinal bypass. Report of 85 cases]
- Author
-
T, Delaunay, C, Peillon, J L, Bourgois, J F, Deotto, L, Lagriffoul, J, Watelet, and J, Testart
- Subjects
Adult ,Aged, 80 and over ,Male ,Reoperation ,Leg ,Anastomosis, Surgical ,Graft Occlusion, Vascular ,Arteries ,Middle Aged ,Amputation, Surgical ,Blood Vessel Prosthesis ,Actuarial Analysis ,Humans ,Female ,Popliteal Artery ,Saphenous Vein ,Vascular Patency ,Aged ,Retrospective Studies - Abstract
From 1975 to 1987, 68 patients were operated with repeated subinguinal bypass (SIB) following early or late thrombosis os an initial bypass graft; 10 were operated with a third SIB, 4 with a fourth SIB. The indication for the second SIB was acute ischemia in 15 cases and chronic ischemia in 53. The graft material used was venous in 21 cases, prosthetic in 29 cases and mixed in 53. The distal anastomosis was performed on the upper popliteal artery in 12 cases, the lower popliteal artery in 34 cases or an artery in leg in 22 cases. The actuarial permeability rate of 84 repeated SIBs, whatever the material, was 21.7% at 1 year (50.2% for venous grafts and 13.6% for prosthetic grafts). The limb preservation rate was 47.9% at 5 years. Operative mortality was about 1%. The analysis of the results suggests that the repeated SIB should be performed only: for limb salvage, if the downstream arterial bed is in good condition, with usable venous material. The risk of having to perform a thigh amputation rather than a leg amputation when attempting repeated SIB is of 13.9% only.
- Published
- 1990
62. [Manometric study of two Roux-en-Y hepatico-jejunostomy]
- Author
-
C, Peillon, P, Ducrotte, C, Duhamel, P, Denis, and J, Testart
- Subjects
Postoperative Care ,Jejunum ,Duodenum ,Manometry ,Biliary Tract Diseases ,Jejunostomy ,Trimebutine ,Humans ,Anastomosis, Roux-en-Y ,Female ,Middle Aged ,Gastrointestinal Motility - Abstract
The aim of this study was to describe (during the fasting state in two patients the motor activity of the limb in Roux-en-Y hepatico-jejunostomy). In the two patients, the limb was created 15 years and 15 days prior to the study respectively. Recordings were performed with a low compliance pneumohydraulic system below the jejuno-jejunal anastomosis then in the limb. Motor studies in the limb were coupled with recordings carried out in the duodenum. In both patients, the regular occurrence of a typical phase III (PIII) activity was demonstrated in the limb whereas no retrograde or abnormal motor patterns were found. PIIIs in the limb were uncoordinated with duodenal PIIIs. Trimebutine, given intravenously, induced a typical PIII activity in the duodenum and the limb simultaneously. Spontaneous or trimebutine-induced PIIIs in the limb had a slower migration velocity (p less than 0.01) than duodenal PIIIs. Lastly, we were unable to record PIIIs in the distal jejunum below the jejuno-jejunal anastomosis despite the lack of associated abnormal motor patterns. This study demonstrates that a normally propagated PIII activity can be observed in the limb in Roux-en-Y hepatico-jejunostomy immediately or several years after the surgical procedure.
- Published
- 1990
63. Quel est votre diagnostic ?
- Author
-
C. Peillon, J. Thiebot, R. Hubrecht, S. Moreno-Swirc, and A. Genevois
- Subjects
Radiological and Ultrasound Technology ,Radiology, Nuclear Medicine and imaging - Published
- 2007
64. Syndrome du marteau: étude retrospective à propos de 30 observations
- Author
-
C. Peillon, I. Marie, F. Hervé, Hervé Levesque, and V. Racle
- Subjects
Cardiology and Cardiovascular Medicine - Published
- 2007
65. Syndrome du marteau: étude rétrospective à propos de 30 observations
- Author
-
V. Racle, C. Peillon, H. Courtois, Nicole Cailleux, Isabelle Marie, and H. Levesque
- Subjects
Gastroenterology ,Internal Medicine - Published
- 2003
66. L'ischémie digitale: une affaire d'internistes. À propos de 96 observations
- Author
-
C. Peillon, H. Courtois, F Lecomte, H. Levesque, Nicole Cailleux, and Isabelle Marie
- Subjects
business.industry ,Gastroenterology ,Internal Medicine ,Medicine ,business - Published
- 1999
67. Aspects cliniques et thérapeutiques des pneumothorax spontanés au cours de l'infection VIH+: neuf observations
- Author
-
S Dominique, G Humbert, I Gueit, C Peillon, and F. Bani-Sadr
- Subjects
Gastroenterology ,Internal Medicine - Published
- 1995
68. Les nécroses digitales du membre supérieur (en dehors de la sclérodermie). Etude rétrospective de 45 observations
- Author
-
N. Cailleux, C. Peillon, Pascal Joly, Jacques Testart, H. Levesque, P. Gilbert, Watelet J, and H. Courtois
- Subjects
Gynecology ,medicine.medical_specialty ,medicine.anatomical_structure ,business.industry ,Gastroenterology ,Internal Medicine ,medicine ,Upper limb ,In patient ,business - Abstract
We report 45 cases of ischaemic problems affecting the upper limb associated with digital necrosis in patients with no systemic sclerosis.
- Published
- 1993
69. Thrombose des veines rénales par coagulopathies acquises: à propos de deux observations
- Author
-
N. Saour, Jacques Testart, H. Levesque, H. Courtois, Jeanne-Yvonne Borg, C. Peillon, and Watelet J
- Subjects
Pathology ,medicine.medical_specialty ,business.industry ,Gastroenterology ,Renal vein thrombosis ,Heparin ,medicine.disease ,Thrombosis ,Primary antiphospholipid syndrome ,medicine.anatomical_structure ,cardiovascular system ,Internal Medicine ,Etiology ,Medicine ,business ,Vein ,medicine.drug - Abstract
We report two cases of renal vein thrombosis, unusual because of acute expression, right vein localization and a never before reported etiology. In one case the thrombosis was secondary to primary antiphospholipid syndrome, in the other it was secondary to heparin associated thrombocythemia.
- Published
- 1992
70. L'ischémie mésentérique chronique d'origine veineuse : une nouvelle entité
- Author
-
C. Peillon, E. Lerebours, R. Colin, F. Cardot, and J Y Borg
- Subjects
medicine.medical_specialty ,Mesenteric infarction ,Adult patients ,business.industry ,medicine.medical_treatment ,Gastroenterology ,Ischemia ,Infarction ,Bowel resection ,medicine.disease ,Surgery ,Angina ,Stenosis ,Internal Medicine ,medicine ,cardiovascular diseases ,business - Abstract
Ten adult patients with venous mesenteric ischacmia were reviewed. Four experienced venous mesenteric infarction ; all required bowel resection. Six others had ischaemia without infarction : four had intestinal angina and one small bowel stenosis. Long term anticoagulation and artifical nutrition were instituted.
- Published
- 1990
71. [Endoluminal angioplasty of iliac obstruction. Immediate results and cumulative patency at 2 years in 23 patients]
- Author
-
E, Cormier, J P, Laissy, J, Bernier, C, Peillon, J, Watelet, J, Testart, and M, Benozio
- Subjects
Adult ,Aged, 80 and over ,Male ,Time Factors ,Humans ,Arterial Occlusive Diseases ,Female ,Middle Aged ,Iliac Artery ,Angioplasty, Balloon ,Vascular Patency ,Aged - Abstract
23 patients with obstruction of one or both main iliac arteries underwent one or more transluminal angioplasties by catheterization via the obstructed vessel. 26 iliac arteries were thus reopened. The length of obstructions varied from 1 to 10 cm. The majority of the obstructions were of recent onset whilst in 6 cases the presumed date was more than 6 months previously. In all cases potency was obtained with normal follow-up angiograms in 20 cases, and a residual though not hemodynamically significant stenosis in 6 cases. All patients were followed up by Doppler and in the majority of cases by venous digital angiography, with a follow-up at the present time of 6 months to 2 years. 2 patients underwent surgery because of reobstruction occurring 2 and 13 months after dilatation. Cumulative patency is 79% in 2 years, similar to results obtained by surgery. These results show that iliac angioplasty, a simple procedure, may avoid or delay surgery, and that it should be widely used in this precise anatomical indication.
- Published
- 1988
72. [Axillary-distal bypass of the upper limb using in situ veins]
- Author
-
C, Peillon, J P, Laissy, E, Calenda, J, Watelet, and J, Testart
- Subjects
Ischemia ,Arm ,Methods ,Humans ,Veins - Abstract
Revascularization of ischaemic upper limbs by means of the patient's superficial veins in situ is a little known technique which has many advantages. Not only is the internal saphenous vein spared, but the technique is easily adaptable to all situations (e.g. length of the bypass, diameter of the arteries).
- Published
- 1989
73. [Reoperations for early thromboses of femoropopliteal and tibial artery bypass. Apropos of 50 cases]
- Author
-
C, Peillon, J P, Laissy, J L, Didelon, J, Watelet, and J, Testart
- Subjects
Femoral Artery ,Male ,Reoperation ,Leg ,Postoperative Complications ,Time Factors ,Humans ,Female ,Popliteal Artery ,Thrombosis ,Prognosis ,Aged ,Retrospective Studies - Abstract
The mechanism of thrombosis early after subinguinal bypass and outcome after revision surgery have been rarely analyzed. Results are reported of revision surgery for early thrombosis in 50 cases (10% of subinguinal bypass operations during the same period). Initial indication in the 40 men and 9 women (mean age 66.9 +/- 1.74 (SEM) years), was severe chronic or acute ischemia in 82%. The 50 thrombosed bypasses included 40 femoropopliteal, 8 femorotibial and 2 short bypasses. The bypass was by saphenous in situ (21 times), an inversed saphenous (9 times), a mixed bypass (12 times) and a prosthesis (8 times). The distal arterial bed was evaluated as good in 50% of cases. Analysis of cause of thrombosis, of the operative procedure and of the time before surgery enabled a technical cause to be determined in 31 of the 50 cases. Corrective surgery produced 16 permeable bypasses and 34 definitive thromboses complicated by 21 amputations and a 10% mortality. Improved results were related to a venous bypass (p less than 0.05), to a time before operation of less than 24 hours (p less than 0.02) and to a good distal bed. The 1 year actuarial permeability for the 50 bypass operations was 35%. Mixed bypass procedures and technical problems during surgery appear to be the principal predisposing factors of early thrombosis. In this series, the preoperative distal pressure index and intraoperative flowmetric recordings were not reliable predictive elements.
- Published
- 1988
74. [A case of colo-anal intussusception in adults surgically treated via the anus]
- Author
-
C, Peillon, T, Delaunay, D, Dadoun, and J, Demelenne
- Subjects
Anus Diseases ,Colonic Diseases ,Colonic Neoplasms ,Methods ,Humans ,Female ,Intussusception ,Aged - Published
- 1988
75. ['Natural history' of arterial surgical restoration below the inguinal region]
- Author
-
J, Testart, J, Watelet, C, Peillon, T, Delaunay, and J L, Bourgois
- Subjects
Adult ,Male ,Leg ,Arterial Occlusive Diseases ,Endarterectomy ,Middle Aged ,Blood Vessel Prosthesis ,Femoral Artery ,Humans ,Female ,Popliteal Artery ,Angioplasty, Balloon ,Vascular Patency ,Aged - Abstract
Infra-inguinal endarterectomy and by-pass (PSI) are the oldest and more frequently done restorative arterial operations. Here are described the evolution of patients, limbs and PSI and the factors that could interfere with them from the facts gathered since 30 years in literature. Prognosis is serious.
- Published
- 1989
76. [Bronchial resection-anastomosis for cicatricial stenosis. Physiopathologic and therapeutic considerations]
- Author
-
D, Benhamou, C, Peillon, M C, Bourreille, J, Testart, and J P, Lemercier
- Subjects
Cicatrix ,Anastomosis, Surgical ,Humans ,Bronchial Diseases ,Female ,Constriction, Pathologic ,Middle Aged ,Foreign Bodies ,Lung - Abstract
The exploration of a stenosis of an intermediate bronchus in a 50 year-old woman showed it to be severe, limited, and non-malignant. Pre-operative angiography showed hypovascularization of the right lower and middle pulmonary lobes. A short resection of the stenosis, with termino-terminal bronchial anastomosis was performed. Post-operative evaluation showed normal bronchography and angiography. This suggests that bronchial stenosis plays a role in the hypovascularization observed before its surgical correction, the most likely hypothesis being vasoconstriction.
- Published
- 1988
77. [Direct puncture of pulseless arteries: a possible angiographic alternative in patients with multiple vessel disease]
- Author
-
J P, Laissy, E, Cormier, J, Bernier, C, Peillon, J, Watelet, J, Testart, and M, Benozio
- Subjects
Adult ,Femoral Artery ,Male ,Arteritis ,Leg ,Aortic Arch Syndromes ,Humans ,Arterial Occlusive Diseases ,Female ,Prospective Studies ,Punctures ,Middle Aged ,Aged - Published
- 1988
78. [Neuroma of the common bile duct: a rare cause of jaundice]
- Author
-
P, Hochain, Y, Duranton, N D, Manchon, C, Peillon, J, Métayer, F, Michot, J, Testart, E, Bercoff, and J, Bourreille
- Subjects
Adult ,Aged, 80 and over ,Male ,Neuroma ,Time Factors ,Common Bile Duct Neoplasms ,Humans ,Jaundice ,Cholecystectomy ,Female ,Middle Aged ,Aged - Abstract
We report a case of neuroma of the main bile duct arising twenty years after cholecystectomy. The patient, a 82-year-old woman, was admitted for jaundice. Endoscopic retrograde cholangiography showed a regular stenosis of the main bile duct. Histologic examination demonstrated neuroma. Based on the analysis of this and 15 other previously published cases, the following features of bile duct neuroma were outlined: a) variable interval between cholecystectomy and the onset of jaundice (6 months to 35 years); b) the generally complicated postoperative course, c) the various localizations on the biliary tree (cystic, main bile duct, intrahepatic bile duct) and, d) the circumstances of onset.
- Published
- 1988
79. [Rectal stenoses caused by carcinoma of the prostate. Apropos of 9 cases]
- Author
-
D, Dadoun, O, Bonnet, C, Peillon, L, Sibert, J M, Muller, and P, Grise
- Subjects
Aged, 80 and over ,Male ,Rectal Diseases ,Humans ,Prostatic Neoplasms ,Constriction, Pathologic ,Middle Aged ,Aged - Abstract
Rectal strictures are rare complications of prostatic cancer and are considered to be a sign of poor prognosis. The authors report 9 cases. In 5 cases, the cancer was already diagnosed and had been treated by endocrine therapy. All patients died during the months following onset of the intestinal symptoms despite diversion colostomy (4 cases) and high dose oestrogen therapy. Rectal strictures therefore have the same poor prognosis as escape from endocrine therapy. In 3 cases, the stricture was the presenting sign of the cancer in one case, the cancer was already known and treated by radiotherapy; in this case, survival depends on the hormone sensitivity of the cancer and one patient survived for 7 years with subsequent closure of the colostomy.
- Published
- 1989
80. Axillo-femoral bypass failure secondary to axillary stenosis: ultrasound-guided percutaneous transluminal angioplasty
- Author
-
J P, Laissy, J, Thiebot, C, Peillon, J, Watelet, J, Testart, and M, Benozio
- Subjects
Male ,Leg ,Arteriosclerosis ,Graft Occlusion, Vascular ,Angiography, Digital Subtraction ,Middle Aged ,Iliac Artery ,Femoral Artery ,Postoperative Complications ,Ischemia ,Axillary Artery ,Humans ,Angioplasty, Balloon ,Ultrasonography - Published
- 1987
81. Perioperative Management of a Patient with Congenital Hypofibrinogenemia
- Author
-
J. Soria, J. Y. Borg, C. Winckler, C. Peillon, H. Courtois, E. Calenda, and H. Levesque
- Subjects
medicine.medical_specialty ,Anesthesiology and Pain Medicine ,Perioperative management ,business.industry ,medicine ,Intensive care medicine ,business ,Congenital hypofibrinogenemia - Published
- 1989
82. First Comparison between [18f]-FMISO and [18f]-Faza for Preoperative Pet Imaging of Hypoxia in Lung Cancer.
- Author
-
Thureau S, Piton N, Gouel P, Modzelewski R, Dujon A, Baste JM, Melki J, Rinieri P, Peillon C, Rastelli O, Lequesne J, Hapdey S, Sabourin JC, Bohn P, and Vera P
- Abstract
Hypoxic areas are typically resistant to treatment. However, the fluorine-18-fluoroazomycin-arabinoside (FAZA) and fluorine 18 misonidazole (FMISO) tracers have never been compared in non small cell lung cancer (NSCLC). This study compares the capability of 18F-FAZA PET/CT with that of 18F-FMISO PET/CT for detecting hypoxic tumour regions in early and locally advanced NSCLC patients. We prospectively evaluated patients who underwent preoperative PET scans before surgery for localised NSCLC (i.e., fluorodeoxyglucose (FDG)-PET, FMISO-PET, and FAZA-PET). The PET data of the three tracers were compared with each other and then compared to immunohistochemical analysis (GLUT-1, CAIX, LDH-5, and HIF1-Alpha) after tumour resection. Overall, 19 patients with a mean age of 68.2 ± 8 years were included. There were 18 lesions with significant uptake (i.e., SUVmax >1.4) for the F-MISO and 17 for FAZA. The mean SUVmax was 3 (±1.4) with a mean volume of 25.8 cc (±25.8) for FMISO and 2.2 (±0.7) with a mean volume of 13.06 cc (±13.76) for FAZA. The SUVmax of F-MISO was greater than that of FAZA ( p = 0.0003). The SUVmax of F-MISO shows a good correlation with that of FAZA at 0.86 (0.66-0.94). Immunohistochemical results are not correlated to hypoxia PET regardless of the staining. The two tracers show a good correlation with hypoxia, with FMISO being superior to FAZA. FMISO, therefore, remains the reference tracer for defining hypoxic volumes.
- Published
- 2021
- Full Text
- View/download PDF
83. Implementation of simulation-based crisis training in robotic thoracic surgery: how to improve safety and performance?
- Author
-
Baste JM, Bottet B, Selim J, Sarsam M, Lefevre-Scelles A, Dusseaux MM, Franchina S, Palenzuela AS, Chagraoui A, Peillon C, Thouroude A, Henry JP, Coq JM, Sibert L, and Damm C
- Abstract
Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form, available at: http://dx.doi.org/10.21037/jtd-2020-epts-03. The series “European Perspectives in Thoracic Surgery (2020) - the Seven Edition” was commissioned by the editorial office without any funding or sponsorship. JMB reports personal fees from Intuitive Surgery, personal fees from Johnson and Johnson, personal fees from Medtronic, during the conduct of the study. ALS reports other from Medtronic, outside the submitted work. CP reports personal fees from covidien, during the conduct of the study. The other authors have no other conflicts of interest to declare.
- Published
- 2021
- Full Text
- View/download PDF
84. TERTp Mutation Detection in Plasma by Droplet-Digital Polymerase Chain Reaction in Spinal Myxopapillary Ependymoma with Lung Metastases.
- Author
-
Deniel A, Marguet F, Beaussire L, Tobenas-Dujardin AC, Peillon C, Gambirasio MA, Veresezan O, Magne N, Di Fiore F, Laquerrière A, Sarafan-Vasseur N, and Fontanilles M
- Subjects
- Adult, Biomarkers, Tumor metabolism, Cell-Free Nucleic Acids metabolism, DNA, Neoplasm metabolism, Ependymoma blood, Ependymoma secondary, Female, Humans, Lung Neoplasms blood, Polymerase Chain Reaction methods, Promoter Regions, Genetic genetics, Spinal Cord Neoplasms blood, Ependymoma genetics, Lung Neoplasms secondary, Mutation genetics, Spinal Cord Neoplasms genetics, Telomerase genetics
- Abstract
Background: Spinal myxopapillary ependymoma (SP-MPE) is a subgroup of ependymomas in which after initial gross tumor resection, recurrences occur in more than half of the patients. Anaplastic transformation may also occur and contributes to intraneural and extraneural metastatic dissemination. Extraneural metastases from SP-MPE are rare and worsen the prognosis. In this situation, the noninvasive detection of recurrent somatic mutations in the circulating tumor DNA (ctDNA) from plasma is challenging. Telomerase-reverse transcriptase gene promoter (TERTp) mutation has been identified in a subset of ependymomas with aggressive behavior., Case Description: We report on a patient with TERTp mutated SP-MPE presenting with an extraneural anaplastic metastatic dissemination after iterative local recurrences. From the initial SP-MPE to pleural anaplastic lesion, TERTp C228T mutation was present with allele frequency varying from 33% to 39%. Interestingly, TERTp mutation was also detected by droplet digital polymerase chain reaction in the plasma with a frequency of 2.1% at the time of pleural metastases, highlighting that ctDNA is released in plasma of patients suffering from SP-MPE with extraneural metastatic dissemination., Conclusions: Despite the rarity of this evolution, plasmatic liquid biopsy appears to be a useful diagnostic and follow-up tool in a subset of primary brain tumors., (Copyright © 2019 Elsevier Inc. All rights reserved.)
- Published
- 2019
- Full Text
- View/download PDF
85. [Stretching and chylothorax].
- Author
-
Bottet B, Melki J, Levesque H, Baste JM, Roussel E, and Peillon C
- Subjects
- Aged, Female, Humans, Chylothorax etiology, Muscle Stretching Exercises adverse effects, Thoracic Duct injuries
- Abstract
Introduction: Chylothorax is a rare cause of pleural effusion. The most common causes are iatrogenic or medical. We report an unusual and rare cause of bilateral chylothorax., Case Report: A 73-year-old woman with no past history was admitted to the emergency department for sudden onset of dyspnoea. Chest X-ray and thoracic CT scan revealed large bilateral pleural effusions. Analysis of the fluid revealed a chylothorax. The patient was treated by chest tube drainage and a fat free (medium chain triglyceride) diet. This led to drying up of the effusions and rapid discharge. Complementary imaging examinations with chest-abdomen-pelvis CT, PET CT and pelvic MRI did not reveal any underlying cause. The final diagnosis was bilateral traumatic chylothorax caused by tearing of the thoracic duct during stretching exercises., Conclusion: Following a literature review, similar cases with the same clinical presentation were found. Combined treatment with thoracic drainage and medium chain triglyceride diet was effective in drying up the effusions. Our diagnosis was a diagnosis of exclusion. It is important to exclude a medical cause by thorough investigation., (Copyright © 2019 SPLF. Published by Elsevier Masson SAS. All rights reserved.)
- Published
- 2019
- Full Text
- View/download PDF
86. A preoperative cotininury test for abdominoplasty reduces peri-operative complications.
- Author
-
Delaunay F, Coquerel-Beghin D, Magalon G, Cohen SR, Casanova D, Niddam J, Milliez PY, Peillon C, Delpierre V, and Auquit-Auckbur I
- Subjects
- Adult, Cohort Studies, Female, Humans, Male, Preoperative Care, Retrospective Studies, Smoking adverse effects, Abdominoplasty, Cotinine urine, Patient Compliance, Postoperative Complications prevention & control, Smoking urine
- Abstract
Background: Smoking induces complications in plastic surgery, in particular wound healing delays. Despite a 4-weeks' abstinence asking before and after surgery, some patients denied or hid their consumption. The aim of this study was to evaluate the effectiveness of a cotininury detection test in terms of improvement in outcomes after an abdominoplasty., Material and Methods: This retrospective cohort study included patients who underwent an abdominoplasty with umbilical transposition and lipoaspiration. Current smokers were asked to stop smoking 4 weeks before and after surgery. After 2013, we performed a preoperative cotininury test for patients having abdominoplasty, with a cancellation of surgery in case of positive result. We analyzed the test's effectiveness on delayed healing and on other complications., Results: Two hundred and thirty-five patients were included; 80 were tested and 21,3% had a positive test. There was significantly less delayed healing in the "screening" group than in the "no screening": 20,3% versus 41,5% (P=0,002). Alike, complications were significantly less frequent in the "screening" group than in the "no screening": 18,1% versus 42,3% (P<0,001)., Conclusion: The routine use of the cotininury test in preoperative abdominoplasties significantly reduces risk of delayed healing and other serious complications. It is an objective test, which is simple, quick and non-invasive. Smoking cessation must be at least 4 weeks before and after the surgery. Following medical advice to cease smoking by the surgeon and anesthetist, referral to an appropriate tobacco-addiction specialist clinic may be helpful for the patient who has difficulty stopping smoking., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)
- Published
- 2018
- Full Text
- View/download PDF
87. Impact of prehabilitation on morbidity and mortality after pulmonary lobectomy by minimally invasive surgery: a cohort study.
- Author
-
Boujibar F, Bonnevie T, Debeaumont D, Bubenheim M, Cuvellier A, Peillon C, Gravier FE, and Baste JM
- Abstract
Background: Thoracic surgery is currently the optimal treatment for non-small cell lung cancer (NSCLC). However, it may be responsible for numerous postoperative complications and is often used in patients with multi co morbidities. In recent years, the optimization of a patient's physical capacity before surgery has been the subject of several studies. The objective of this study was to determine whether participation in a prehabilitation program would improve outcomes after surgery and lower morbidity according to the Clavien-Dindo classification., Methods: This retrospective cohort study was performed between 1st January 2014 and 31st January 2016 at Rouen University Hospital. All adult patients with NSCLC (IIIa or <) who had pulmonary lobectomy by minimally invasive surgery and cardiopulmonary exercise testing [CPET (VO2max ≤20 mL/min/kg)] were included., Results: The cohort included 38 patients. Two groups were formed: one group with prehabilitation (n=19) and one group without prehabilitation (n=19). Four patients were not included leaving 34 patients for the final analysis. Most patients with a Clavien-Dindo grade of ≤2 had received prehabilitation compared to patients who had not received prehabilitation, respectively 17/19 vs. 8/15; P=0.0252. Patients who had received prehabilitation had fewer postoperative complications than patients who had not received prehabilitation, respectively 8/19 vs. 12/15; P=0.0382., Conclusions: We have shown that prehabilitation has a positive impact on the occurrence and severity of postoperative complications after pulmonary lobectomy by minimally invasive surgery. Further studies conducted in larger populations are warranted to confirm these results., Competing Interests: Conflicts of Interest: Dr. Baste and Prof. Peillon are consultants for Medtronic and Intuitive surgery.
- Published
- 2018
- Full Text
- View/download PDF
88. Development of a precision multimodal surgical navigation system for lung robotic segmentectomy.
- Author
-
Baste JM, Soldea V, Lachkar S, Rinieri P, Sarsam M, Bottet B, and Peillon C
- Abstract
Minimally invasive sublobar anatomical resection is becoming more and more popular to manage early lung lesions. Robotic-assisted thoracic surgery (RATS) is unique in comparison with other minimally invasive techniques. Indeed, RATS is able to better integrate multiple streams of information including advanced imaging techniques, in an immersive experience at the level of the robotic console. Our aim was to describe three-dimensional (3D) imaging throughout the surgical procedure from preoperative planning to intraoperative assistance and complementary investigations such as radial endobronchial ultrasound (R-EBUS) and virtual bronchoscopy for pleural dye marking. All cases were operated using the DaVinci System
TM . Modelisation was provided by Visible Patient™ (Strasbourg, France). Image integration in the operative field was achieved using the Tile Pro multi display input of the DaVinci console. Our experience was based on 114 robotic segmentectomies performed between January 2012 and October 2017. The clinical value of 3D imaging integration was evaluated in 2014 in a pilot study. Progressively, we have reached the conclusion that the use of such an anatomic model improves the safety and reliability of procedures. The multimodal system including 3D imaging has been used in more than 40 patients so far and demonstrated a perfect operative anatomic accuracy. Currently, we are developing an original virtual reality experience by exploring 3D imaging models at the robotic console level. The act of operating is being transformed and the surgeon now oversees a complex system that improves decision making., Competing Interests: Conflicts of Interest: Jean Marc Baste declares lecturing and proctoring for Intuitive Surgical. The other authors have no conflicts of interest to declare.- Published
- 2018
- Full Text
- View/download PDF
89. Robot-assisted ligation of bronchial artery could be an alternative to embolization.
- Author
-
Pochulu B, Sarsam O, Peillon C, and Baste JM
- Subjects
- Adult, Angiography, Bronchial Arteries diagnostic imaging, Embolization, Therapeutic, Hemoptysis diagnostic imaging, Hemoptysis surgery, Humans, Minimally Invasive Surgical Procedures, Tomography, X-Ray Computed, Bronchial Arteries surgery, Robotic Surgical Procedures
- Abstract
A 37-year-old patient presented with a self-limiting episode of moderate haemoptysis. Contrast-enhanced chest computed tomography showed a tortuous and dilated right bronchial artery arising from the descending aorta at the level of T6. Therapeutic angiography was attempted, but in the presence of spinal artery arising from the bronchial artery in question, selective embolization was contraindicated due to risk of spinal cord ischaemia. After a multidisciplinary meeting, it was decided to attempt surgery to ligate this pathological artery. We performed minimally invasive robot-assisted ligation of this pathological artery. The postoperative course was uneventful with good clinical and radiological outcome at 3-month follow-up. A minimally invasive approach provides a real alternative to embolization and could be a therapeutic option.
- Published
- 2018
- Full Text
- View/download PDF
90. Three-dimensional computed tomography reconstruction for operative planning in robotic segmentectomy: a pilot study.
- Author
-
Le Moal J, Peillon C, Dacher JN, and Baste JM
- Abstract
Background: The objective of our pilot study was to assess if three-dimensional (3D) reconstruction performed by Visible Patient™ could be helpful for the operative planning, efficiency and safety of robot-assisted segmentectomy., Methods: Between 2014 and 2015, 3D reconstructions were provided by the Visible Patient™ online service and used for the operative planning of robotic segmentectomy. To obtain 3D reconstruction, the surgeon uploaded the anonymized computed tomography (CT) image of the patient to the secured Visible Patient™ server and then downloaded the model after completion., Results: Nine segmentectomies were performed between 2014 and 2015 using a pre-operative 3D model. All 3D reconstructions met our expectations: anatomical accuracy (bronchi, arteries, veins, tumor, and the thoracic wall with intercostal spaces), accurate delimitation of each segment in the lobe of interest, margin resection, free space rotation, portability (smartphone, tablet) and time saving technique., Conclusions: We have shown that operative planning by 3D CT using Visible Patient™ reconstruction is useful in our practice of robot-assisted segmentectomy. The main disadvantage is the high cost. Its impact on reducing complications and improving surgical efficiency is the object of an ongoing study., Competing Interests: Conflicts of Interest: JM Baste discloses fees for lecturing and proctoring for Intuitive Surgical. This work was presented at the French Thoracic and Cardio-Vascular Society autumn 2017 meeting.
- Published
- 2018
- Full Text
- View/download PDF
91. Pleural Dye Marking Using Radial Endobronchial Ultrasound and Virtual Bronchoscopy before Sublobar Pulmonary Resection for Small Peripheral Nodules.
- Author
-
Lachkar S, Baste JM, Thiberville L, Peillon C, Rinieri P, Piton N, Guisier F, and Salaun M
- Subjects
- Aged, Bronchoscopy, Female, Humans, Male, Middle Aged, Multiple Pulmonary Nodules surgery, Retrospective Studies, Robotic Surgical Procedures, Methylene Blue, Multiple Pulmonary Nodules diagnostic imaging, Thoracic Surgery, Video-Assisted, Ultrasonography, Interventional methods
- Abstract
Background: Minimally invasive surgery of pulmonary nodules allows suboptimal palpation of the lung compared to open thoracotomy., Objective: The objective of this study was to assess endoscopic pleural dye marking using radial endobronchial ultrasound (r-EBUS) and virtual bronchoscopy to localize small peripheral lung nodules immediately before minimally invasive resection., Methods: The endoscopic procedure was performed without fluoroscopy, under general anesthesia in the operating room immediately before minimally invasive surgery. Then, 1 mL of methylene blue (0.5%) was instilled into the guide sheath, wedged in the subpleural space. Wedge resection or segmentectomy were guided by visualization of the dye on the pleural surface. Contribution of dye marking to the surgical procedure was rated by the surgeon., Results: Twenty-five nodules, including 6 ground glass opacities, were resected in 22 patients by video-assisted thoracoscopic wedge resection (n = 11) or robotic-assisted thoracoscopic surgery (10 segmentectomies and 1 wedge resection). The median greatest diameter of nodules was 8 mm. No conversion to open thoracotomy was needed. The endoscopic procedure added an average 10 min to surgical resection. The dye was visible on the pleural surface in 24 cases. Histological diagnosis and free margin resection were obtained in all cases. Median skin-to-skin operating time was 90 min for robotic segmentectomy and 40 min for video-assisted wedge resection. The same operative precision was considered impossible by the surgeon without dye marking in 21 cases., Conclusions: Dye marking using r-EBUS and virtual bronchoscopy can be easily and safely performed to localize small pulmonary nodules immediately before minimally invasive resection., (© 2018 S. Karger AG, Basel.)
- Published
- 2018
- Full Text
- View/download PDF
92. Exhaustive preoperative staging increases survival in resected adrenal oligometastatic non-small-cell lung cancer: a multicentre study.
- Author
-
De Wolf J, Bellier J, Lepimpec-Barthes F, Tronc F, Peillon C, Bernard A, Le Rochais JP, Tiffet O, Sage E, Chapelier A, and Porte H
- Subjects
- Adrenal Gland Neoplasms mortality, Adrenal Gland Neoplasms surgery, Adult, Aged, Carcinoma, Non-Small-Cell Lung mortality, Carcinoma, Non-Small-Cell Lung surgery, Disease-Free Survival, Female, France epidemiology, Humans, Lung Neoplasms mortality, Lung Neoplasms surgery, Male, Middle Aged, Preoperative Period, Prognosis, Retrospective Studies, Survival Rate trends, Adrenal Gland Neoplasms secondary, Adrenalectomy, Carcinoma, Non-Small-Cell Lung secondary, Lung Neoplasms pathology, Neoplasm Staging methods
- Abstract
Objectives: Adrenal oligometastatic non-small-cell lung cancer is rare, and surgical management remains controversial., Methods: We performed a multicentre, retrospective study from January 2004 to December 2014. The main objective was to evaluate survival in patients who had undergone adrenalectomy after resection of primary lung cancer. Secondary objectives were to determine prognostic, survival and recurrence factors., Results: Fifty-nine patients were included. Forty-six patients (78%) were men. The median age was 58 years [39-75 years]. Twenty-six cases (44%) showed synchronous presentation, and 33 cases (56%) had a metachronous presentation. The median time to onset of metastasis was 18.3 months [6-105 months]. The 5-year overall survival rate was 59%; the median survival time was 77 months [0.6-123 months]. A recurrence was observed in 70% of the population. Mediastinal lymph node invasion (P = 0.035) is a detrimental prognostic factor of survival., Conclusions: After exhaustive staging, patients with adrenal oligometastatic non-small-cell lung cancer benefit from bifocal surgery., (© The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)
- Published
- 2017
- Full Text
- View/download PDF
93. The Interest of Performing "On-Demand Chest X-rays" after Lung Resection by Minimally Invasive Surgery.
- Author
-
Haddad L, Bubenheim M, Bernard A, Melki J, Peillon C, and Baste JM
- Subjects
- Aged, Chest Tubes, Drainage instrumentation, France, Humans, Length of Stay, Male, Middle Aged, Pneumonectomy adverse effects, Pneumonectomy mortality, Postoperative Complications mortality, Postoperative Complications therapy, Predictive Value of Tests, Prospective Studies, Time Factors, Treatment Outcome, Health Services Needs and Demand, Pneumonectomy methods, Postoperative Complications diagnostic imaging, Radiography, Thoracic, Robotic Surgical Procedures adverse effects, Robotic Surgical Procedures mortality, Thoracic Surgery, Video-Assisted adverse effects, Thoracic Surgery, Video-Assisted mortality
- Abstract
Background There is a lack of consensus in hospital centers regarding costly daily routine chest X-rays after lung resection by minimally invasive surgery. Indeed, there is no evidence that performing daily chest X-rays prevents postoperative complications. Our objective was to compare chest X-rays performed on demand when there was clinical suspicion of postoperative complications and chest X-rays performed systematically in daily routine practice. Methods This prospective single-center study compared 55 patients who had on-demand chest X-rays and patients in the literature who had daily routine chest X-rays. Our primary evaluation criterion was length of hospitalization. Results The length of hospitalization was 5.3 ± 3.3 days for patients who had on-demand X-rays, compared with 4 to 9.7 days for patients who had daily routine X-rays. Time to chest tube removal (4.34 days), overall complication rate (27.2%), reoperation rate (3.6%), and mortality rate (1.8%) were comparable to those in the literature. On average, our patients only had 1.22 ± 1.8 on-demand X-rays, compared with 3.3 X-rays if daily routine protocol had been applied. Patients with complications had more X-rays (3.4 ± 1.8) than patients without complications (0.4 ± 0.7). Conclusion On-demand chest X-rays do not seem to delay the diagnosis of postoperative complications or increase morbidity-mortality rates. Performing on-demand chest X-rays could not only simplify surgical practice but also have a positive impact on health care expenses. However, a broader randomized study is warranted to validate this work and ultimately lead to national consensus., Competing Interests: Disclosure The authors report no conflicts of interest in this work., (Georg Thieme Verlag KG Stuttgart · New York.)
- Published
- 2017
- Full Text
- View/download PDF
94. The affordability of minimally invasive procedures in major lung resection: a prospective study.
- Author
-
Gondé H, Laurent M, Gillibert A, Sarsam OM, Varin R, Grimandi G, Peillon C, and Baste JM
- Subjects
- Aged, Costs and Cost Analysis, Female, Follow-Up Studies, Humans, Lung Neoplasms economics, Male, Middle Aged, Minimally Invasive Surgical Procedures economics, Pneumonectomy economics, Prospective Studies, Robotics economics, Hospital Costs, Lung Neoplasms surgery, Minimally Invasive Surgical Procedures methods, Pneumonectomy methods, Robotics methods, Thoracic Surgery, Video-Assisted methods
- Abstract
Objectives: Minimally invasive procedures are used for the surgical treatment of lung cancer. Two techniques are proposed: video-assisted thoracic surgery or robotic-assisted thoracic surgery. Our goal was to study the economic impact of our long-standing program for minimally invasive procedures for major lung resection., Methods: We conducted a single-centre, 1-year prospective cost study. Patients who underwent lobectomy or segmentectomy were included. Patient characteristics and perioperative outcomes were collected. Medical supply expenses based on the microcosting method and capital depreciation were estimated. Total cost was evaluated using a national French database., Results: One hundred twelve patients were included, 57 with and 55 without robotic assistance. More segmentectomies were performed with robotic assistance. The median length of stay was 5 days for robotic-assisted and 6 days for video-assisted procedures (P = 0.13). The duration of median chest drains (4 days, P = 0.36) and of operating room time (255 min, P = 0.55) was not significantly different between the groups. The overall conversion rate to thoracotomy was 9%, significantly higher in the video-assisted group than in the robotic group (16% vs 2%, P = 0.008). No difference was observed in postoperative complications. The cost of most robotic-assisted procedures ranged from €10 000 to €12 000 (median €10 972) and that of most video-assisted procedures ranged from €8 000 to €10 000 (median €9 637) (P = 0.007); median medical supply expenses were €3 236 and €2 818, respectively (P = 0.004). The overall mean cost of minimally invasive techniques (€11 759) was significantly lower than the mean French cost of lung resection surgical procedures (€13 424) (P = 0.001)., Conclusions: The cost at our centre of performing minimally invasive surgical procedures appeared lower than the cost nationwide. Robotic-assisted thoracic surgery demonstrated acceptable additional costs for a long-standing program., (© The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)
- Published
- 2017
- Full Text
- View/download PDF
95. [Thymomectomy by minimally invasive surgery. Comparative study videosurgery versus robot-assisted surgery].
- Author
-
Witte Pfister A, Baste JM, Piton N, Bubenheim M, Melki J, Wurtz A, and Peillon C
- Subjects
- Adult, Aged, Female, Humans, Male, Middle Aged, Minimally Invasive Surgical Procedures adverse effects, Morbidity, Postoperative Complications epidemiology, Retrospective Studies, Robotic Surgical Procedures adverse effects, Thoracic Surgery, Video-Assisted adverse effects, Thymectomy adverse effects, Thymoma epidemiology, Thymoma surgery, Thymus Neoplasms epidemiology, Thymus Neoplasms surgery, Minimally Invasive Surgical Procedures methods, Robotic Surgical Procedures methods, Thoracic Surgery, Video-Assisted methods, Thymectomy methods
- Abstract
Objectives: To report the results of minimally invasive surgery in patients with stage I or II thymoma in the Masaoka classification. The reference technique is partial or complete thymectomy by sternotonomy., Methods: A retrospective single-center study of a prospective database including all cases of thymoma operated from April 2009 to February 2015 by minimally invasive techniques: either videosurgery (VATS) or robot-assisted surgery (RATS). The surgical technique, type of resection, length of hospital stay, postoperative complications and recurrences were analysed., Results: Our series consisted of 22 patients (15 women and 7 men). The average age was 53 years. Myasthenia gravis was present in 12 patients. Eight patients were operated on by VATS and 14 patiens by RATS. There were no conversions to sternotomy and no perioperative deaths. The mean operating time was 92min for VATS and 137min for RATS (P<0.001). The average hospital stay was 5 days. The mean weight of the specimen for the VATS group was 13.2 and 45.7mg for the RATS group. Twelve patients were classified Masaoka stage I and 10 were stage II. According to the WHO classification there were 7 patients type A, 5 type AB, 4 type B1, 4 type B2 4 and 2 type B3. As proposed by the Group ITMIG-IASLC in 2015 all patients corresponded to group I. The mean follow-up period was 36 months. We noted 3 major perioperative complications according to the Clavien-Dindo classification: one pneumonia, one phrenic nerve paralysis and one recurrent laryngeal nerve palsy. We observed one case of local recurrence at 22 months. Following surgery 4 patients were treated with radiotherapy and 2 patients with chemotherapy., Conclusions: The minimally invasive route is safe, relatively atraumatic and may be incorporated in the therapeutic arsenal for the treatment of Masaoka stage I and II thymoma as an alternative to conventional sternotomy. RATS and VATS are two minimally invasive techniques and the results in the short and medium term are acceptable. The clinical advantages of one over the other are sifficult to establish. RATS could handle larger and more complex lesions in view of the weight and size of the operating instrument., (Copyright © 2017 SPLF. Published by Elsevier Masson SAS. All rights reserved.)
- Published
- 2017
- Full Text
- View/download PDF
96. When and how should we manage thoracic aortic injuries in the modern era?
- Author
-
Bottet B, Bouchard F, Peillon C, and Baste JM
- Subjects
- Aorta, Thoracic surgery, Aortic Rupture diagnosis, Humans, Male, Thoracic Injuries diagnosis, Tomography, X-Ray Computed, Vascular System Injuries diagnosis, Wounds, Nonpenetrating diagnosis, Young Adult, Aorta, Thoracic injuries, Aortic Rupture surgery, Thoracic Injuries surgery, Vascular Surgical Procedures methods, Vascular System Injuries surgery, Wounds, Nonpenetrating surgery
- Abstract
A best evidence topic in cardiovascular surgery was written according to a structured protocol. The question addressed was what are the optimum treatment modality and timing of intervention for blunt thoracic aortic injury (BTAI) in the modern era? Of the 697 papers found using the reported search, 14 (5 meta-analyses, 2 prospective and 7 retrospective studies) represented the best evidence to answer the clinical question. The author, journal, country, date of publication, patient group studied, study type, relevant outcomes, results and weakness of these papers are tabulated. All five meta-analyses reported a reduction in mortality with thoracic endovascular aortic repair (TEVAR) compared with open repair (OR), but only four found the same benefit on paraplegia rate. Similarly, the two prospective and four retrospective studies showed significantly lower mortality with TEVAR than with OR. Only one study (a meta-analysis) reported a significantly lower stroke rate with TEVAR than with OR, whereas the 13 others reported a similar or even higher stroke rate. Other complication rates were identical. Four studies demonstrated that non-operative management (NOM) as a treatment option for BTAI was associated with increased mortality, even if it has declined in recent years. One study emphasized that some cases with minimal aortic injuries (Grade I and II on CT scan) could benefit from NOM. Regarding the timing of repair, only three studies analysed outcomes of delayed repair and reported significantly lower mortality than for early repair. We conclude that with lower mortality and similar overall complications including paraplegia but higher stroke rate, TEVAR is the most suitable treatment for BTAI in the modern era, where expertise exists, especially for cases of multiple associated injuries and in the older age group. Delayed aortic repair can be proposed based on CT scan analysis, but emergent repair should still be advocated for imminent free aortic rupture. NOM remains a therapeutic option but only with selected patients., (© The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)
- Published
- 2016
- Full Text
- View/download PDF
97. Video-assisted thoracic surgery for left upper lobectomy for complex lesions: how to extend the indication with optimal safety?
- Author
-
Bayard NF, Barnett SA, Rinieri P, Melki J, Peillon C, and Baste JM
- Subjects
- Carcinoma, Non-Small-Cell Lung pathology, Female, Follow-Up Studies, Humans, Imaging, Three-Dimensional, Middle Aged, Neoplasm Invasiveness pathology, Neoplasm Staging, Patient Safety, Treatment Outcome, Carcinoma, Non-Small-Cell Lung surgery, Pneumonectomy methods, Thoracic Surgery, Video-Assisted methods
- Abstract
The feasibility of extending the VATS approach to locally advanced NSCLC has been described with good clinical outcome. These complex resections are still technically challenging and patient safety must remain the highest priority. In this article, we describe our routine VATS approach for left upper lobectomy in proximal, locally advanced lesions. Both surgical and anaesthesiology teams are trained during simulation sessions to respond rapidly in case of urgent thoracotomy. Encircling arterial and venous vessels allow control of inadvertent bleeding during difficult dissection. Also, whenever needed the double vessel control technique is a time saver waiting for conversion to thoracotomy.
- Published
- 2016
- Full Text
- View/download PDF
98. Physiologic assessment before video thoracoscopic resection for lung cancer in patients with abnormal pulmonary function.
- Author
-
Benattia A, Debeaumont D, Guyader V, Tardif C, Peillon C, Cuvelier A, and Baste JM
- Abstract
Background: Impaired respiratory function may prevent curative surgery for patients with non-small cell lung cancer (NSCLC). Video-assisted thoracoscopic surgery (VATS) reduces postoperative morbility-mortality and could change preoperative assessment practices and therapeutic decisions. We evaluated the relation between preoperative pulmonary function tests and the occurrence of postoperative complications after VATS pulmonary resection in patients with abnormal pulmonary function., Methods: We included 106 consecutive patients with ≤80% predicted value of presurgical expiratory volume in one second (FEV1) and/or diffusing capacity of carbon monoxide (DLCO) and who underwent VATS pulmonary resection for NSCLC from a prospective surgical database., Results: Patients (64±9.5 years) had lobectomy (n=91), segmentectomy (n=7), bilobectomy (n=4), or pneumonectomy (n=4). FEV1 and DLCO preoperative averages were 68%±21% and 60%±18%. Operative mortality was 1.89%. Only FEV1 was predictive of postoperative complications [odds ratio (OR), 0.96; 95% confidence interval (CI), 0.926-0.991, P=0.016], but there was no determinable threshold. Twenty-five patients underwent incremental exercise testing. Desaturations during exercise (OR, 0.462; 95% CI, 0.191-0.878, P=0.039) and heart rate (HR) response (OR, 0.953; 95% CI, 0.895-0.993, P=0.05) were associated with postoperative complications., Conclusions: FEV1 but not DLCO was a significant predictor of pulmonary complications after VATS pulmonary resection despite a low rate of severe morbidity. Incremental exercise testing seems more discriminating. Further investigation is required in a larger patient population to change current pre-operative threshold in a new era of minimally invasive surgery.
- Published
- 2016
- Full Text
- View/download PDF
99. Robot-Assisted Thoracoscopic Surgery versus Video-Assisted Thoracoscopic Surgery for Lung Lobectomy: Can a Robotic Approach Improve Short-Term Outcomes and Operative Safety?
- Author
-
Mahieu J, Rinieri P, Bubenheim M, Calenda E, Melki J, Peillon C, and Baste JM
- Subjects
- Blood Loss, Surgical, Clinical Competence, Conversion to Open Surgery, Databases, Factual, Female, France, Humans, Learning Curve, Length of Stay, Male, Middle Aged, Operative Time, Pneumonectomy adverse effects, Postoperative Complications etiology, Retrospective Studies, Risk Factors, Time Factors, Treatment Outcome, Pneumonectomy methods, Robotic Surgical Procedures adverse effects, Thoracic Surgery, Video-Assisted adverse effects
- Abstract
Background Minimally invasive surgery has been recently recommended for treatment of early-stage non-small cell lung cancer. Despite the recent increase of robotic surgery, the place and potential advantages of the robot in thoracic surgery has not been well defined until now. Methods We reviewed our prospective database for retrospective comparison of our first 28 video-assisted thoracoscopic surgery lobectomies (V group) and our first 28 robotic lobectomies (R group). Results No significant difference was shown in median operative time between the two groups (185 vs. 190 minutes, p = 0.56). Median preincision time was significantly longer in the R group (80 vs. 60 minutes, P < 0.0001). The rate of emergency conversion for uncontrolled bleeding was lower in the R group (one vs. four). Median length of stay was comparable (6 days in the R group vs. 7 days in the V group, p = 0.4) with no significant difference in the rate of postoperative complications (eight Grade I in both groups, four Grade III or IV in the V group vs. six in the R group, according to the Clavien-Dindo classification, p = 0.93). No postoperative cardiac morbidity was observed in the R group. Median drainage time was similar (5 days, p = 0.78), with a rate of prolonged air leak slightly higher in the R group (25 vs. 17.8%, p = 0.74). Conclusion Perioperative outcomes are similar even in the learning period but robotic approach seems to offer more operative safety with fewer conversions for uncontrolled bleeding., (Georg Thieme Verlag KG Stuttgart · New York.)
- Published
- 2016
- Full Text
- View/download PDF
100. Morbidity-mortality conference for adverse events associated with totally implanted venous access for cancer chemotherapy.
- Author
-
Merle V, Marini H, Di Fiore F, Lottin M, Gray C, Loeb A, Fred A, Contentin N, Muir JF, Thiberville L, Pfister C, Huet E, Peillon C, Michel P, and Czernichow P
- Subjects
- Central Venous Catheters statistics & numerical data, Female, Humans, Male, Morbidity, Neoplasms complications, Neoplasms drug therapy, Prospective Studies, Quality of Life, Central Venous Catheters adverse effects, Neoplasms mortality
- Abstract
Purpose: Although considered safer than central venous catheters for administration of cancer chemotherapy, totally implanted venous access (TIVA) is associated with adverse events that may impair prognosis and quality of life of patients receiving chemotherapy. Our aim was to assess the feasibility and interest of surveillance of cancer chemotherapy TIVA-adverse events (AE), associated with morbidity-mortality conferences (MMCs) on TIVA-AE., Methods: We performed a prospective interventional study in two hospitals (a university hospital and a comprehensive care center). For each cancer chemotherapy care pathway within each hospital, we set up surveillance of TIVA-AE and MMC on these events. Patients included in surveillance were those with a TIVA either placed or used for chemotherapy cycles in one of the participating wards. Feasibility of MMC was assessed by the number of MMC meetings that actually took place and the number of participants at each meeting. The interest of MMC was assessed by the number of TIVA-AE identified and analyzed, and the number and type of improvement actions selected and actually implemented., Results: We recorded 0.41 adverse events per 1000 TIVA-day. MMCs were implemented in all care pathways, with sustained pluriprofessional attendance throughout the survey; 39 improvement actions were identified during meetings, and 18 were actually implemented., Conclusions: Surveillance of TIVA-AE associated with MMC is feasible and helps change practices. It could be useful for improving care of patients undergoing cancer chemotherapy.
- Published
- 2016
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.