Lotfi Benhamed - Academia.edu (original) (raw)
Papers by Lotfi Benhamed
Journal of Thoracic Oncology, 2009
To determine the lymphatic spread frequency and location in patients, who underwent lung resectio... more To determine the lymphatic spread frequency and location in patients, who underwent lung resection for carcinoid tumors, associated with systematic nodal dissection. Methods: From January 1998 to June 2007, 54 patients underwent anatomic lung resection associated with systematic nodal dissection for tumors classified as typical (TC) or atypical carcinoid according to 1999 World Health Organization criteria. The number and location of the resected lymph nodes were specified. All patients were followed up. Results: All patients underwent complete resection (R0) that were anatomic in 32 patients (59.2%), and associated with a bronchoplastic procedure in 22 (40.8%). Low morbidity was related to lymphadenectomy. The mean number of resected lymph nodes was of 18 (range, 7-44) per patient, which pathologic studies demonstrated lymphatic spread in 10 patients (18.5%). In the TC group (n ϭ 42) 2 patients were classified N1 (4.8%) and 4 N2 (9.5%). In the atypical group (n ϭ 12) 2 patients were classified N1 (16.6%) and 2 N2 (16.6%).
The Annals of Thoracic Surgery, 2008
Downloaded from and colleagues with the use of Ultraflex metallic stents in benign airway obstruc... more Downloaded from and colleagues with the use of Ultraflex metallic stents in benign airway obstruction [1], we have to report our recent experience of granulation tissue formation at the end of two Ultraflex metallic tracheal stents that had as result late tracheal obstruction, and to advise caution with the use of metallic stents in benign airway obstruction.
![Research paper thumbnail of [Malformations of the anterior chest wall]](https://attachments.academia-assets.com/39168844/thumbnails/1.jpg)
](Revue des maladies respiratoires, 2007
Pectus excavatum or funnel chest is the most common anterior chest wall deformity seen in childre... more Pectus excavatum or funnel chest is the most common anterior chest wall deformity seen in children and adults. The sternal depression appears to be caused by overgrowth of the costal cartilages, also the cause of the less common deformities: pectus carinatum (pigeon breast) and pectus arcuatum. Usually the overgrowth involves the third to seventh costal cartilages but it can be more or less extensive. The cardiopulmonary functional consequences are insignificant in the protrusional deformities and inconsistent in pectus excavatum and the indications for surgery are mainly cosmetic. The procedural modalities are guided by morphological study of the CT scan. We describe a surgical technique that comprise subperichondrial excision of all deformed costal cartilages followed by transverse sternotomy to correct the sternal deformity, anteriorly in the case of pectus excavatum and posteriorly for pectus carinatum and arcuatum. As the perichondrial sheaths are totally preserved they are sut...
The Annals of Thoracic Surgery, 2014
Interactive CardioVascular and Thoracic Surgery, 2013
Interactive CardioVascular and Thoracic Surgery, 2013
EMC - Tecniche Chirurgiche - Chirurgia Generale, 2009
ABSTRACT Le malformazioni più frequenti della parete del torace interessano il piastrone condrost... more ABSTRACT Le malformazioni più frequenti della parete del torace interessano il piastrone condrosternale. Hanno come causa uno sviluppo eccessivo delle cartilagini costali, che respingono e deformano il corpo dello sterno posteriormente, pectus excavatum (o torace a imbuto) e, anteriormente, pectus carinatum (o torace a carena) e pectus arcuatum. Esistono anche alcune malformazioni isolate dello sterno: sono le fessure sternali consecutive a un difetto di fusione, sulla linea mediana, degli abbozzi sternali nel corso della vita embrionale. Altre malformazioni sono rare, addirittura eccezionali: la sindrome di Poland, caratterizzata nelle forme complete da un’ipoplasia monolaterale della parete toracica e da una brachisindattilia ipsilaterale, la sindrome di Jeune, che è una distrofia toracica asfissiante legata a un difetto dello sviluppo della gabbia toracica, di origine congenita, e la distrofia toracica acquisita, sequela di un intervento per pectus excavatum nell’infanzia. Infine, sono descritte alcune malformazioni diverse, delle cartilagini tipo iperplasia localizzata e delle coste tipo aplasia, sinostosi o bifidità.
EMC - Tecniche Chirurgiche Torace, 2009
ABSTRACT La tracheotomia viene definita come l’incisione della trachea cervicale seguita dal posi... more ABSTRACT La tracheotomia viene definita come l’incisione della trachea cervicale seguita dal posizionamento di una cannula. La tracheostomia viene definita invece come l’anastomosi permanente della trachea alla cute. Dopo aver esaminato le tracheotomie utilizzate in chirurgia toracica, come la tracheotomia per la ventilazione assistita nello pneumectomizzato e la tracheotomia per l’intubazione selettiva bilaterale ed esclusione delle rotture iatrogene basse della trachea, gli autori descrivono la gestione di alcune complicanze postoperatorie: la fistola tracheoarteriosa e la persistenza dell’orifizio della tracheotomia. Infine vengono descritte le diverse tecniche di tracheostomia cervicale e mediastinica come la tracheostomia mediastinica anteriore dopo tracheolaringectomia o nuova resezione della trachea cervicale con ricostruzione mediante lembo muscolocutaneo a isola di gran pettorale.
Interactive CardioVascular and Thoracic Surgery, 2014
Interactive CardioVascular and Thoracic Surgery, 2013
Revue des Maladies Respiratoires, 2007
Introduction Les malformations les plus fréquentes de la paroi thoracique antérieure intéressent ... more Introduction Les malformations les plus fréquentes de la paroi thoracique antérieure intéressent le plastron chondrosternal. Elles ont pour cause un développement excessif des cartilages costaux, qui refoulent et déforment le corps sternal, en arrière : pectus excavatum (ou thorax en entonnoir), ou en avant : pectus carinatum (ou thorax en carène) et pectus arcuatum.
Interactive CardioVascular and Thoracic Surgery, 2014
We read with great interest the article by Maurizi and colleagues demonstrating the relevance of ... more We read with great interest the article by Maurizi and colleagues demonstrating the relevance of the surgical treatment for bronchial carcinoid tumours . In particular, they underlined the need for systematic nodal dissection, and the value of lung sparing surgery. In a previous article, we reported our experience, with 54 patients undergoing operation for both typical (n = 42) and atypical (n = 12) carcinoid tumours classified according to the definitive criteria of the World Health Organization . Regarding the lymph node status, our results differed from those reported by Maurizi and colleagues. Following systematic nodal dissection (with a mean of 18 resected nodes), our patients showed a significant higher rate of mediastinal involvement (6/54, 11% vs 2/65, 3% in the authors' series). Interestingly, in our typical carcinoid group, the four N2 patients (9.5%) were found to have a single skip metastasis not discovered by preoperative evaluation. A similar finding was also shown in one patient (8.3%) in the atypical group. Furthermore we demonstrated that significantly higher frequency of lymphatic spread was observed in patients aged inferior or equal to 35 years and tumor size superior or equal to 3 cm. Despite the fact that in bronchial carcinoids, mediastinal relapses are quite rare and appear in the long term [3], our findings contradict the opinion of Dutterbeck who stated in 2010: "there is a little reason to expect a therapeutic benefit from mediastinal lymph node dissection" in clinical N0 carcinoid tumours of typical feature . In the same way as Maurizi et al., we are convinced of the value of bronchoplastic techniques in the surgical treatment of carcinoid tumours. In our series of 54 patients, 22 (40.8%) underwent such lung sparing procedures, and, to the best of our knowledge, this is the highest rate reported in the literature. Confirming literature data , associated lymph node dissection led to low morbidity in our experience, and neither fistula nor ischaemic damage to the airway was observed. With this surgical strategy only distant recurrence was shown in 4 patients (7.4%) leading to death in 3. Finally, with a median follow-up of 57 months our overall survival rate was 92.6%, with no significant differences between typical and atypical carcinoid groups, and patients with or without lymphatic spread .
Interactive CardioVascular and Thoracic Surgery, 2010
Interactive CardioVascular and Thoracic Surgery, 2010
http://icvts.ctsnetjournals.org/cgi/content/full/11/3/333 located on the World Wide Web at:
Journal of Thoracic Oncology, 2009
To determine the lymphatic spread frequency and location in patients, who underwent lung resectio... more To determine the lymphatic spread frequency and location in patients, who underwent lung resection for carcinoid tumors, associated with systematic nodal dissection. Methods: From January 1998 to June 2007, 54 patients underwent anatomic lung resection associated with systematic nodal dissection for tumors classified as typical (TC) or atypical carcinoid according to 1999 World Health Organization criteria. The number and location of the resected lymph nodes were specified. All patients were followed up. Results: All patients underwent complete resection (R0) that were anatomic in 32 patients (59.2%), and associated with a bronchoplastic procedure in 22 (40.8%). Low morbidity was related to lymphadenectomy. The mean number of resected lymph nodes was of 18 (range, 7-44) per patient, which pathologic studies demonstrated lymphatic spread in 10 patients (18.5%). In the TC group (n ϭ 42) 2 patients were classified N1 (4.8%) and 4 N2 (9.5%). In the atypical group (n ϭ 12) 2 patients were classified N1 (16.6%) and 2 N2 (16.6%).
The Journal of Thoracic and Cardiovascular Surgery, 2008
on their patient who experienced dehiscence of the preserved noncoronary sinus after subcoronary ... more on their patient who experienced dehiscence of the preserved noncoronary sinus after subcoronary allograft replacement of the aortic valve. The authors write that this complication might not be unique for this method of allograft implantation and that it could in fact occur with any type of inclusion technique, as long as sinuses are retained. They also suggest that some methods of insertion of stentless xenograft valves could also be liable to this complication.
The Journal of Thoracic and Cardiovascular Surgery, 2013
The action of the respiratory muscle during inspiration expands the chest, which lowers the press... more The action of the respiratory muscle during inspiration expands the chest, which lowers the pressure in the thoracic cavity. The lower pressure allows for increased venous return, heart filling, and cardiac output, the so-called respiratory blood pump. Chest deformity such as pectus excavatum (PEx) can alter the development of negative pulmonary pressure, which could explain the impaired cardiovascular function. 1,2 Because cardiovascular function is the limiting factor for oxygen delivery to the tissues at maximal exercise, we hypothesized that the reduced aerobic capability in patients with PEx could be the result of impaired inspiratory muscle strength to generate negative pulmonary pressure, thus limiting venous return and cardiac output. Specifically, we tested whether PEx deformity would be associated with reduced respiratory muscle strength, as evaluated by the maximal inspiratory pressures, and whether surgery would improve the aerobic capacity by the increased respiratory pump efficacy and better cardiovascular adaptation.
European Journal of Cardio-Thoracic Surgery, 2011
Objective: Severe pectus excavatum are common in adult patients, often causing psychological comp... more Objective: Severe pectus excavatum are common in adult patients, often causing psychological complaints and physiological impairments. Although lung function at rest may minimally deteriorate after surgical correction, it remains unclear if surgery improves exercise capacity. The objective of present study is to assess whether the surgical repair of pectus excavatum in adults would improve exercise tolerance. Methods: A prospective study was performed to compare pulmonary and cardiovascular function at rest and at maximal exercise, before, and at 1 year after pectus excavatum repair. Results: From December 2005 to May 2009, 120 adult patients underwent pectus excavatum repair. Of these patients, 70 (nine women, 61 men) underwent thorough preoperative, 6-, and 12-month postoperative assessments, and were included in the present study. Age ranged from 18 to 62 years (mean 27 years). The pectus index (Haller index) was 4.5 AE 1.1. Lung function tests at rest were within the normal range, whereas maximal oxygen uptake (peak VO 2 ) was only 77 AE 2% of the predicted value. At 1-year follow-up, the pectus excavatum repair was associated with minor changes in lung function tests and significant increase ( p = 0.0005) in VO 2 (87 AE 2% of the predicted value). Postoperative O 2 pulse increase at maximal exercise suggested that aerobic capacity improvement was the result of better cardiovascular adaptation at maximal workload. Conclusion: These results demonstrate sustained improvement in exercise cardiopulmonary function at 1-year follow-up of pectus excavatum surgical repair in adult patients. #
Journal of Thoracic Oncology, 2009
To determine the lymphatic spread frequency and location in patients, who underwent lung resectio... more To determine the lymphatic spread frequency and location in patients, who underwent lung resection for carcinoid tumors, associated with systematic nodal dissection. Methods: From January 1998 to June 2007, 54 patients underwent anatomic lung resection associated with systematic nodal dissection for tumors classified as typical (TC) or atypical carcinoid according to 1999 World Health Organization criteria. The number and location of the resected lymph nodes were specified. All patients were followed up. Results: All patients underwent complete resection (R0) that were anatomic in 32 patients (59.2%), and associated with a bronchoplastic procedure in 22 (40.8%). Low morbidity was related to lymphadenectomy. The mean number of resected lymph nodes was of 18 (range, 7-44) per patient, which pathologic studies demonstrated lymphatic spread in 10 patients (18.5%). In the TC group (n ϭ 42) 2 patients were classified N1 (4.8%) and 4 N2 (9.5%). In the atypical group (n ϭ 12) 2 patients were classified N1 (16.6%) and 2 N2 (16.6%).
The Annals of Thoracic Surgery, 2008
Downloaded from and colleagues with the use of Ultraflex metallic stents in benign airway obstruc... more Downloaded from and colleagues with the use of Ultraflex metallic stents in benign airway obstruction [1], we have to report our recent experience of granulation tissue formation at the end of two Ultraflex metallic tracheal stents that had as result late tracheal obstruction, and to advise caution with the use of metallic stents in benign airway obstruction.
Revue des maladies respiratoires, 2007
Pectus excavatum or funnel chest is the most common anterior chest wall deformity seen in childre... more Pectus excavatum or funnel chest is the most common anterior chest wall deformity seen in children and adults. The sternal depression appears to be caused by overgrowth of the costal cartilages, also the cause of the less common deformities: pectus carinatum (pigeon breast) and pectus arcuatum. Usually the overgrowth involves the third to seventh costal cartilages but it can be more or less extensive. The cardiopulmonary functional consequences are insignificant in the protrusional deformities and inconsistent in pectus excavatum and the indications for surgery are mainly cosmetic. The procedural modalities are guided by morphological study of the CT scan. We describe a surgical technique that comprise subperichondrial excision of all deformed costal cartilages followed by transverse sternotomy to correct the sternal deformity, anteriorly in the case of pectus excavatum and posteriorly for pectus carinatum and arcuatum. As the perichondrial sheaths are totally preserved they are sut...
The Annals of Thoracic Surgery, 2014
Interactive CardioVascular and Thoracic Surgery, 2013
Interactive CardioVascular and Thoracic Surgery, 2013
EMC - Tecniche Chirurgiche - Chirurgia Generale, 2009
ABSTRACT Le malformazioni più frequenti della parete del torace interessano il piastrone condrost... more ABSTRACT Le malformazioni più frequenti della parete del torace interessano il piastrone condrosternale. Hanno come causa uno sviluppo eccessivo delle cartilagini costali, che respingono e deformano il corpo dello sterno posteriormente, pectus excavatum (o torace a imbuto) e, anteriormente, pectus carinatum (o torace a carena) e pectus arcuatum. Esistono anche alcune malformazioni isolate dello sterno: sono le fessure sternali consecutive a un difetto di fusione, sulla linea mediana, degli abbozzi sternali nel corso della vita embrionale. Altre malformazioni sono rare, addirittura eccezionali: la sindrome di Poland, caratterizzata nelle forme complete da un’ipoplasia monolaterale della parete toracica e da una brachisindattilia ipsilaterale, la sindrome di Jeune, che è una distrofia toracica asfissiante legata a un difetto dello sviluppo della gabbia toracica, di origine congenita, e la distrofia toracica acquisita, sequela di un intervento per pectus excavatum nell’infanzia. Infine, sono descritte alcune malformazioni diverse, delle cartilagini tipo iperplasia localizzata e delle coste tipo aplasia, sinostosi o bifidità.
EMC - Tecniche Chirurgiche Torace, 2009
ABSTRACT La tracheotomia viene definita come l’incisione della trachea cervicale seguita dal posi... more ABSTRACT La tracheotomia viene definita come l’incisione della trachea cervicale seguita dal posizionamento di una cannula. La tracheostomia viene definita invece come l’anastomosi permanente della trachea alla cute. Dopo aver esaminato le tracheotomie utilizzate in chirurgia toracica, come la tracheotomia per la ventilazione assistita nello pneumectomizzato e la tracheotomia per l’intubazione selettiva bilaterale ed esclusione delle rotture iatrogene basse della trachea, gli autori descrivono la gestione di alcune complicanze postoperatorie: la fistola tracheoarteriosa e la persistenza dell’orifizio della tracheotomia. Infine vengono descritte le diverse tecniche di tracheostomia cervicale e mediastinica come la tracheostomia mediastinica anteriore dopo tracheolaringectomia o nuova resezione della trachea cervicale con ricostruzione mediante lembo muscolocutaneo a isola di gran pettorale.
Interactive CardioVascular and Thoracic Surgery, 2014
Interactive CardioVascular and Thoracic Surgery, 2013
Revue des Maladies Respiratoires, 2007
Introduction Les malformations les plus fréquentes de la paroi thoracique antérieure intéressent ... more Introduction Les malformations les plus fréquentes de la paroi thoracique antérieure intéressent le plastron chondrosternal. Elles ont pour cause un développement excessif des cartilages costaux, qui refoulent et déforment le corps sternal, en arrière : pectus excavatum (ou thorax en entonnoir), ou en avant : pectus carinatum (ou thorax en carène) et pectus arcuatum.
Interactive CardioVascular and Thoracic Surgery, 2014
We read with great interest the article by Maurizi and colleagues demonstrating the relevance of ... more We read with great interest the article by Maurizi and colleagues demonstrating the relevance of the surgical treatment for bronchial carcinoid tumours . In particular, they underlined the need for systematic nodal dissection, and the value of lung sparing surgery. In a previous article, we reported our experience, with 54 patients undergoing operation for both typical (n = 42) and atypical (n = 12) carcinoid tumours classified according to the definitive criteria of the World Health Organization . Regarding the lymph node status, our results differed from those reported by Maurizi and colleagues. Following systematic nodal dissection (with a mean of 18 resected nodes), our patients showed a significant higher rate of mediastinal involvement (6/54, 11% vs 2/65, 3% in the authors' series). Interestingly, in our typical carcinoid group, the four N2 patients (9.5%) were found to have a single skip metastasis not discovered by preoperative evaluation. A similar finding was also shown in one patient (8.3%) in the atypical group. Furthermore we demonstrated that significantly higher frequency of lymphatic spread was observed in patients aged inferior or equal to 35 years and tumor size superior or equal to 3 cm. Despite the fact that in bronchial carcinoids, mediastinal relapses are quite rare and appear in the long term [3], our findings contradict the opinion of Dutterbeck who stated in 2010: "there is a little reason to expect a therapeutic benefit from mediastinal lymph node dissection" in clinical N0 carcinoid tumours of typical feature . In the same way as Maurizi et al., we are convinced of the value of bronchoplastic techniques in the surgical treatment of carcinoid tumours. In our series of 54 patients, 22 (40.8%) underwent such lung sparing procedures, and, to the best of our knowledge, this is the highest rate reported in the literature. Confirming literature data , associated lymph node dissection led to low morbidity in our experience, and neither fistula nor ischaemic damage to the airway was observed. With this surgical strategy only distant recurrence was shown in 4 patients (7.4%) leading to death in 3. Finally, with a median follow-up of 57 months our overall survival rate was 92.6%, with no significant differences between typical and atypical carcinoid groups, and patients with or without lymphatic spread .
Interactive CardioVascular and Thoracic Surgery, 2010
Interactive CardioVascular and Thoracic Surgery, 2010
http://icvts.ctsnetjournals.org/cgi/content/full/11/3/333 located on the World Wide Web at:
Journal of Thoracic Oncology, 2009
To determine the lymphatic spread frequency and location in patients, who underwent lung resectio... more To determine the lymphatic spread frequency and location in patients, who underwent lung resection for carcinoid tumors, associated with systematic nodal dissection. Methods: From January 1998 to June 2007, 54 patients underwent anatomic lung resection associated with systematic nodal dissection for tumors classified as typical (TC) or atypical carcinoid according to 1999 World Health Organization criteria. The number and location of the resected lymph nodes were specified. All patients were followed up. Results: All patients underwent complete resection (R0) that were anatomic in 32 patients (59.2%), and associated with a bronchoplastic procedure in 22 (40.8%). Low morbidity was related to lymphadenectomy. The mean number of resected lymph nodes was of 18 (range, 7-44) per patient, which pathologic studies demonstrated lymphatic spread in 10 patients (18.5%). In the TC group (n ϭ 42) 2 patients were classified N1 (4.8%) and 4 N2 (9.5%). In the atypical group (n ϭ 12) 2 patients were classified N1 (16.6%) and 2 N2 (16.6%).
The Journal of Thoracic and Cardiovascular Surgery, 2008
on their patient who experienced dehiscence of the preserved noncoronary sinus after subcoronary ... more on their patient who experienced dehiscence of the preserved noncoronary sinus after subcoronary allograft replacement of the aortic valve. The authors write that this complication might not be unique for this method of allograft implantation and that it could in fact occur with any type of inclusion technique, as long as sinuses are retained. They also suggest that some methods of insertion of stentless xenograft valves could also be liable to this complication.
The Journal of Thoracic and Cardiovascular Surgery, 2013
The action of the respiratory muscle during inspiration expands the chest, which lowers the press... more The action of the respiratory muscle during inspiration expands the chest, which lowers the pressure in the thoracic cavity. The lower pressure allows for increased venous return, heart filling, and cardiac output, the so-called respiratory blood pump. Chest deformity such as pectus excavatum (PEx) can alter the development of negative pulmonary pressure, which could explain the impaired cardiovascular function. 1,2 Because cardiovascular function is the limiting factor for oxygen delivery to the tissues at maximal exercise, we hypothesized that the reduced aerobic capability in patients with PEx could be the result of impaired inspiratory muscle strength to generate negative pulmonary pressure, thus limiting venous return and cardiac output. Specifically, we tested whether PEx deformity would be associated with reduced respiratory muscle strength, as evaluated by the maximal inspiratory pressures, and whether surgery would improve the aerobic capacity by the increased respiratory pump efficacy and better cardiovascular adaptation.
European Journal of Cardio-Thoracic Surgery, 2011
Objective: Severe pectus excavatum are common in adult patients, often causing psychological comp... more Objective: Severe pectus excavatum are common in adult patients, often causing psychological complaints and physiological impairments. Although lung function at rest may minimally deteriorate after surgical correction, it remains unclear if surgery improves exercise capacity. The objective of present study is to assess whether the surgical repair of pectus excavatum in adults would improve exercise tolerance. Methods: A prospective study was performed to compare pulmonary and cardiovascular function at rest and at maximal exercise, before, and at 1 year after pectus excavatum repair. Results: From December 2005 to May 2009, 120 adult patients underwent pectus excavatum repair. Of these patients, 70 (nine women, 61 men) underwent thorough preoperative, 6-, and 12-month postoperative assessments, and were included in the present study. Age ranged from 18 to 62 years (mean 27 years). The pectus index (Haller index) was 4.5 AE 1.1. Lung function tests at rest were within the normal range, whereas maximal oxygen uptake (peak VO 2 ) was only 77 AE 2% of the predicted value. At 1-year follow-up, the pectus excavatum repair was associated with minor changes in lung function tests and significant increase ( p = 0.0005) in VO 2 (87 AE 2% of the predicted value). Postoperative O 2 pulse increase at maximal exercise suggested that aerobic capacity improvement was the result of better cardiovascular adaptation at maximal workload. Conclusion: These results demonstrate sustained improvement in exercise cardiopulmonary function at 1-year follow-up of pectus excavatum surgical repair in adult patients. #