Gilles Beauchamp

Clinical spectrum of bronchogenic cysts of the mediastinum and lung in the adult

Bronchogenic cysts are closed sacs considered to be the result of an abnormal budding of the respiratory system. They are lined by ciliated epithelium and have focal areas of hyaline cartilage, smooth muscle, and bronchial glands within their walls. They are seldom seen in the adult, and most are thought to be asymptomatic and free of complications. During a 20-year period, 86 patients underwent resection of a bronchogenic cyst of the mediastinum (66 patients) and lung (20 patients). There were 47 women and 39 men whose ages ranged from 16 to 69 years. Seventy-two percent of patients (67% with mediastinal cysts and 90% with cysts of the lung) were symptomatic at the time of operation, and the majority had two or more symptoms. Despite extensive investigations, which in some cases included computed tomographic scanning (n = 12) and angiography (n = 22), a positive diagnosis was never made preoperatively even if it was suspected in 57% of patients. In nearly all patients, the operative approach was that of a posterolateral thoracotomy. All but two mediastinal bronchogenic cysts could be locally excised, but all bronchogenic cysts of the lung required pulmonary resection (lobectomy, 13; limited resection, 6; pneumonectomy, 1). Major operative difficulties were encountered in 35 patients, all of whom were symptomatic preoperatively. Thirty-three patients had a complicated cyst; the complications consisted of fistulization (n = 16), ulcerations of the cyst wall (n = 13), hemorrhage (n = 2), infection without fistulization (n = 1), and secondary bronchial atresia (n = 1). Overall, 82% of patients had a bronchogenic cyst that was either symptomatic or complicated or both.(ABSTRACT TRUNCATED AT 250 WORDS)

Impact of deferred treatment of blunt diaphragmatic rupture: A 15-year experience in six trauma centers in Quebec

BACKGROUND The purpose of this study was to show that blunt diaphragmatic rupture does not require immediate emergency operation in the absence of other indications. METHODS We reviewed all patients with blunt diaphragmatic rupture admitted within 24 hours of injury to one of six university trauma centers providing trauma care for the province of Quebec from April 1, 1984, to March 31, 1999. Multivariate analysis of demographic profiles, severity indices, indications for operation, and preoperative delays was performed. RESULTS There were 160 patients (91 men and 69 women) with blunt diaphragmatic rupture. Mean age was 40.1 +/- 16.2 years. Mean Injury Severity Score was 26.9 +/- 11.5 and mortality was 14.4%. Patients undergoing emergency surgery for indications other than diaphragmatic rupture had a significantly higher Injury Severity Score than those undergoing surgery for repair of diaphragmatic rupture alone (34.7 +/- 10.7 vs. 22.0 +/- 9.0, p < 0.001). In patients undergoing surgery for diaphragmatic rupture alone, delay before repair of the diaphragmatic hernia did not lead to an increased mortality compared with patients undergoing immediate surgery (3.4% vs. 5.0%, p = NS). CONCLUSION Blunt diaphragmatic rupture in the absence of other surgical injuries carries low mortality. Operative repair of diaphragmatic rupture can be deferred without appreciable increased mortality if no other indication mandates immediate surgery.

Blunt diaphragmatic rupture

Diaphragmatic injury is often a missed diagnosis in patients with multiple trauma. For this reason, mortality can be high. From 1970 to 1981, 32 patients with diaphragmatic injuries were seen at Maisonneuve-Rosemont Hospital. Twenty-four of the patients (22 men and 2 women aged 18 to 79 years) had blunt abdominal or thoracic trauma causing diaphragmatic disruption. Rupture occurred 20 times on the left side of the diaphragm, and 3 times on the right side. There was one pericardiophrenic rupture. Motor vehicle accident was the most common cause of trauma. On arrival, 21 patients had acute diaphragmatic rupture. Clinical signs and radiography permitted early diagnosis in 15 patients, whereas diagnosis was made later in 3 other patients because of deterioration of vital signs. In two patients, diagnosis was made at laparotomy for another reason. Four patients were operated on for post-traumatic chronic diaphragmatic hernia. The abdominal approach was used in 18 patients, the thoracic approach in 4, and the thoracoabdominal approach in 2. Three patients died, two of whom had a late diagnosis. Fourteen patients had no complications. Diaphragmatic trauma can be easily managed surgically when diagnosis is made early after trauma. It must always be looked for in patients with multiple trauma.

Oropharyngeal Dysphagia and Oculopharyngeal Muscular Dystrophy

Oculopharyngeal muscular dystrophy is an autosomal dominant transmitted condition seen mainly in French Canada. The largest number of publications on these patients concerns a Quebec family whose descendants have spread throughout the United States. Families of different ethnic origins have also been reported from around the world, although there is no evidence that the neuromuscular disease reported is the same, despite the similarity of the syndrome. When severe oropharyngeal dysphagia results, these patients can significantly benefit from a cricopharyngeal myotomy.

Gastroesophageal Reflux and Obesity

It is a widely held belief that obese patients are more prone to gastroesophageal reflux. The influence of obesity is also thought to be deleterious to the results of surgery. Whether such beliefs are justified is addressed by this paper.

Nuclear medicine and esophageal surgery

The principal radionuclide procedures involved in the evaluation of esophageal disorders that are amenable to surgery are illustrated and briefly described. The role of the radionuclide esophagogram (RE) in the diagnosis and management of achalasia, oculopharyngeal muscular dystrophy and its complications, tracheoesophageal fistulae, pharyngeal and esophageal diverticulae, gastric transposition, and fundoplication is discussed. Detection of columnar-lined esophagus by Tc-99m pertechnetate imaging and of esophageal carcinoma by Ga-67 citrate and Tc-99m glucoheptonate studies also is presented.

The technique of cricopharyngeal myotomy.

The surgical approach for section of the cricopharyngeus muscle in the treatment of oropharyngeal dysphagia is outlined.

Solitary fibrous tumour of the pleura: A case report

Solitary fibrous tumours of the pleura are rare pleural neoplasms that are distinct from mesothelioma. Most of them are benign, although some behave aggressively; morphological and pathological features are important in distinguishing them from mesothelioma and in predicting clinical behaviour. Solitary fibrous tumours often grow to a large size before causing symptoms, and are characteristically associated with hypertrophic pulmonary osteoarthropathy in up to 20% of cases. In cases of benign lesions, complete resection is usually curative. A case involving a 62-year-old woman who underwent surgical resection of a solitary fibrous tumour of the pleura measuring 25 cm in size is described.

Surgical education in the canadian socialized health care system

The International Surgical Week (ISW) met in Toronto more than 15 years ago, and since then the practice of surgery in Canada has changed significantly. During that interval the Canadian Health Care System (CHCS) has entered into a crisis followed by a reform that is still ongoing. The crisis has touched all aspects of the surgical practice as well as medical education. What has happened in the CHCS during the last 15 years? Has the training of the residents in surgery been altered by the evolution and changes in the CHCS? What are the events that have modified the training of our surgical residents? What have been the reactions and responses of university departments of surgery to deal with the heath care crisis and its impact on the surgical training? These are some of the questions that visitors, especially our neighbors from the United States may ask Canadian surgeons at the ISW meeting this year in Montreal. American surgeons are practicing in a very different health care system. Some think that the Canadian surgeons are working in a socialized health care system that is not very efficient. This article should shed some light on the recent evolution of the CHCS. Although there are great similarities between the Canadian provinces, the province of Quebec is renowned for having the most socialized health care system in Canada. My comments are based on my experience as a chairman of a university department of surgery in that province. Canadian health care system

The Physiologic Basis for the Medical Management of Gastroesophageal Reflux

Most of the patients with gastroesophageal reflux can be helped by simple measures. The small proportion of patients who require intensive medical therapy may be treated in a logical fashion. This review briefly examines some of the factors upon which the rational medical treatment of reflux disease is based.