Pulmonary sequestration: a review of 26 cases.

OBJECTIVES: Pulmonary sequestration is a continuum of lung anomalies for which no single embryonic hypothesis is yet available. The aim of this study was to assess the diagnostic tools and treatment for the rare condition, pulmonary sequestration, in an unspecialised centre. METHODS: We performed an analysis of 26 cases of pulmonary sequestration (paediatric and adult) operated at the Centre Hospitalier Universitaire Vaudois between May 1959 and May 1997. A review of the extralobar and intralobar types of sequestrations is discussed. Angiography is compared to other diagnostic tools in this condition, and treatment is discussed. RESULTS: Twenty-six cases of pulmonary sequestrations, a rare congenital pulmonary malformation, were operated on in the defined time period. Seventy-three percent (19) of the cases were intralobar and 27% (seven) extralobar. Extralobar localisation was basal in 71% and situated between the upper and the lower lobe in 29%. In six cases, the diagnosis was made by exploratory thoracotomy. In the other 20 cases, diagnosis was evoked on chest X-ray and confirmed by angiography. Lobectomy (46%) was the most common treatment procedure. Segmental resection was performed in 30% of the cases and bilobectomy in 4%. Post-operative morbidity was low. The most significant complications were pleural empyema, haemothorax and haemopneumoperitoneum in case of extralobar sequestration. There was no evidence of metaplasia or pre-neoplastic changes. CONCLUSIONS: Despite its rarity, some radiological features are sufficiently suggestive of diagnosis of pulmonary sequestration. Investigations are necessary in order to avoid unexpected pathology at the time of operation. Resection of the involved lung leads to excellent results and the long-term outcome is highly favourable.

[Systematic use of a "swan neck" catheter for peritoneal dialysis: first evaluation]. / Emploi systématique du cathéter arqué en col de cygne "swan neck" pour dialyse péritonéale: première appréciation.

We inserted a "swan neck" peritoneal dialysis catheter in 26 patients between January 1991 and December 1992. We report our results in the 24 patients that we were able to follow: they were satisfactory but the exit-site infection rate was too high. Postoperative care of the catheter is of paramount importance to prevent such complications.

[Surgery for bronchial carcinoma with mediastinal lymph node involvement]. / Chirurgie du carcinome bronchique avec envahissement nodulaire médiastinal.

Or the 3000 patients analyzed in the prospective bronchial carcinoma field study, 1086 were operated between 1984 and 1989. Complete systematic mediastinal lymphadenectomy was performed in 661 patients to assess the PTNM stage as exactly as possible, and to improve prognosis. Lymphadenectomy removes all hylarand mediastinal lymph nodes. Although the operation is technically quite easy on the clearly structured right side, it is more difficult on the left side due to the aortic arch and its branches. The lymph nodes of the upper mediastinum of the left and right side can be completely dissected by mobilizing the aortic arch with the left subclavian artery. In contrast to what is frequently assumed, the histological findings indicate that there is no general pattern of metastatic spread in the lymph nodes. The metastases can leave out varying numbers of lymph nodes craniad as well as caudad. For this reason, the lymph nodes have to be completely resected to ensure a real R0-resection.

Herpes simplex esophagitis after renal transplantation.

This paper describes five renal transplant recipients, out of a series of 221 consecutive patients, who developed herpes simplex esophagitis. This opportunistic infection presented as odyno- and/or dysphagia. It occurred during or shortly after treatment of acute cellular rejection episodes with high doses of steroids and, in four cases, of anti-lymphocyte globulins. The infection responded to acyclovir in all patients. We conclude from these observations that herpes esophagitis occurs during periods of intensive immunosuppression. Because its endoscopic manifestations are variable, biopsies and cultures are essential to reach the diagnosis. Prevention may be possible by avoiding transplantation from a seropositive donor to a negative recipient and by prophylactic oral acyclovir.

[Surgical treatment of Budd-Chiari syndrome and veno-occlusive disease]. / Traitement chirurgical du syndrome de Budd-Chiari et de la maladie veino-occlusive.

We operated 5 patients with the Budd-Chiari syndrome or veno-occlusive disease between 1984 and 1989 (2 porto-caval shunts, one Warren distal spleno-renal shunt, one meso-atrial shunt and one Le Veen peritoneo-jugular shunt). As liver transplantation is now part of the therapeutic armamentarium for these conditions, this paper reviews retrospectively the indications for surgery in these 5 patients.

[The fate of Warren's splenorenal shunt in the era of sclerotherapy]. / Devenir du shunt splénorénal distal selon Warren à l'ére de la sclérothérapie.

From 1969 to 1990, 52 patients underwent splenorenal shunt after one or more esophageal variceal hemorrhages. Sixty days' mortality was 15.4% (8 deaths). 3 patients were lost to follow-up soon after hospital discharge. The remaining 41 patients could be followed for 5.5 years on average: 26 died, 3 were lost to follow-up late after discharge and 12 are presently alive. Only 4 of the followed-up patients suffered recurrent bleeding due to a thrombosed shunt. Temporary mental disturbances were noted in 4 cases but no incapacitating encephalopathy was recorded. In the last 10 years, performance of the Warren shunt has decreased strikingly as a result of the increasing popularity of endoscopic sclerotherapy. Surgical and anesthetic techniques have, however, improved too, resulting in a lower morbidity and mortality rate. Recurrent bleeding and neurological sequelae being rare, we conclude that distal splenorenal shunt remains a valuable alternative to long-term sclerotherapy in selected cases.

Portal vein thrombosis of the adolescent: indications for autologous internal jugular vein interposition meso-caval shunt.

Endoscopic sclerotherapy is now the treatment of first choice for oesophageal varices. However, in spite of its efficiency and safety, recurrent bleeding remains possible and oesophageal sclerosis does not cure other potentially incapacitating symptoms related to portal hypertension. This report describes four adolescents with prehepatic hypertension for whom sclerotherapy was inadequate. They were treated successfully by an autologous internal jugular vein interposition mesocaval shunt. This operation is safe, decompresses the whole splanchnic territory and obviates the need for long term endoscopic surveillance.