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Biomedical subjects

C T Bolliger

Publications and source records attributed to C T Bolliger.

At least 19 recordsLinked to original sources
PubMed1996

An Airway Wallstent for the treatment of tracheobronchial malignancies.

BACKGROUND: The palliative effect of a new Airway Wallstent with a polyurethane covering was tested in patients with inoperable malignant lesions of the central airways. METHODS: Thirty six stents were inserted in 27 patients with obstruction (n = 24) or fistulae (n = 3), 15 of whom later received radiotherapy. The degree of symptom relief was assessed 1, 30, and 90 days after stent insertion. RESULTS: Stent deployment was successful in all patients. Significant improvements were observed one day after placement compared with before placement, with no change at 30 and 90 days, in dyspnoea index (mean (SD) 3.2 (0.7) before stent insertion compared with 1.8 (0.7) one day after insertion); Karnofsky index (32 (18) before insertion compared with 55 (15) one day after insertion); and obstruction of airway diameter (85 (11)% before insertion compared with 10 (12)% on day 1 after stent insertion). Stent-related complications needing later interventions included retained secretions (five patients), granuloma formation at ends of the stent (four patients), and stent migration (four patients). Over a median observation period of two months (range two days to 8.5 months) all stent coverings remained intact without delamination or tumour ingrowth. CONCLUSIONS: The Airway Wallstent provided excellent palliation for malignant obstructions and fistulae of the central airways. Retention of secretions and granuloma formation at the ends of the stent warrant minor technical improvements.

Adult↗
PubMed1996

Pulmonary function and exercise capacity after lung resection.

The influence of pulmonary resection on functional capacity can be assessed in different ways. The aim of this study was to compare the effect of lobectomy and pneumonectomy on pulmonary function tests (PFT), exercise capacity and perception of symptoms. Sixty eight patients underwent functional assessment with PFT and exercise testing before (Preop), and 3 and 6 months after lung resection. In 50 (36 males and 14 females; mean age 61 yrs) a lobectomy was performed and in 18 (13 males and 5 females; mean age 59 yrs) a pneumonectomy was performed. Three months after lobectomy, forced vital capacity (FVC), forced expiratory volume in one second (FEV1), total lung capacity (TLC), transfer factor of the lungs for carbon monoxide (TL,CO) and maximal oxygen uptake (V'O2,max) were significantly lower than Preop values, increasing significantly from 3 to 6 months after resection. Three months after pneumonectomy, all parameters were significantly lower than Preop values and significantly lower than postlobectomy values and did not recover from 3 to 6 months after resection. At 6 months after resection significant deficits persisted in comparison with Preop: for FVC 7% and 36%, FEV1 9% and 34%, TLC 10% and 33% for lobectomy and pneumonectomy, respectively; and V'O2,max 20% after pneumonectomy only. Exercise was limited by leg muscle fatigue in 53% of all patients at Preop. This was not altered by lobectomy, but there was a switch to dyspnoea as the limiting factor after pneumonectomy (61% of patients at 3 months and 50% at 6 months after resection). Furthermore, pneumonectomy compared to lobectomy led to a significantly smaller breathing reserve (mean +/- SD) (28 +/- 13 vs 37 +/- 16% at 3 months; and 24 +/- 11% vs 33 +/- 12% at 6 months post resection) and lower arterial oxygen tension at peak exercise 10.1 +/- 1.5 vs 11.5 +/- 1.6 kPa (76 +/- 11 vs 86 +/- 12 mmHg) at 3 months; 10.1 +/- 1.3 vs 11.3 +/- 1.6 kPa (76 +/- 10 vs 85 +/- 12 mmHg) at 6 months postresection. We conclude that measurements of conventional pulmonary function tests alone overestimate the decrease in functional capacity after lung resection. Exercise capacity after lobectomy is unchanged, whereas pneumonectomy leads to a 20% decrease, probably due to the reduced area of gas exchange.

Adult↗
PubMed1996

The use of the covered Wallstent for the palliative treatment of inoperable tracheobronchial cancers. A prospective, multicenter study.

STUDY OBJECTIVE: To investigate the safety, efficacy, and tolerance of the covered Wallstent for the palliative treatment of inoperable tracheobronchial cancer. DESIGN: An 8-month prospective study employing either a rigid bronchoscope or a flexible delivery system for prosthesis insertion. SETTING: Multicentric setting involving four teaching hospitals in Switzerland and Germany. PATIENTS: Forty patients (29 men, 11 women), average age of 62 years, presenting with an inoperable tracheobronchial cancer. INTERVENTIONS: After partial airway recanalization with an Nd-YAG laser, the covered Wallstent was inserted 23 times using a rigid bronchoscope (Rigidstep device), and 27 times using a flexible delivery system (Telestep device) under fluoroscopic and endoscopic visualization. RESULTS: Clinical and endoscopic examination at 1, 30, and 90 days showed improvement in the bronchial lumen and in the dyspnea index. No serious complication (death, perforation, hemorrhage, inability to remove an improperly placed prosthesis) was observed during surgery. Late complications included migration (12%), inflammatory granulations or tumor regrowth at the tip of the prosthesis (36%), and symptomatic retention of secretion (38%). CONCLUSIONS: Compared with other tracheobronchial prostheses, notably the Dumon stent, the covered Wallstent presents the following advantages: insertion with visual guidance, treatment of extrinsic compressions and esophagobronchial fistulas, and little chance of migration when the prosthesis diameter is chosen correctly. The following disadvantages can be noted: high price; both repositioning and extraction of the released stent are more difficult, though certainly possible; and risk of granulations at the tips of the prosthesis and retention of secretions. Suggestions are made for potential improvements to the stent and insertion system that may result in a significant decrease in early and late complications.

Adult↗
PubMed1996

[Lung scintigraphy and ergospirometry in prediction of postoperative course in lung resection candidates with increased risk of postoperative complications].

Patients with impaired pulmonary function are at increased risk for the development of postoperative complications. We therefore analyzed the value of preoperative lung scanning and exercise testing for the prediction of postoperative complications and of the short- as well as long-term performance in lung resection candidates at increased risk for complications. Twenty-five (mean age 63 y; 17 m) out of 84 consecutive lung resection candidates were considered at increased risk for postoperative complications due to impaired pulmonary function (FEV1 < 2L or diffusion for carbon monoxide (DLCO) < 50% predicted, or FEV1 and DLCO < or = 80% predicted combined with New York Heart Association dyspnea index > or = 2). Candidates underwent radionuclide perfusion scans and exercise testing to predict postoperative ( = ppo) values for FEV1, DLCO and maximal O2-uptake (VO2max). They all underwent thoracotomy for neoplastic lesions; 7 had pneumonectomies, 18 lobectomies. Six had postoperative complications (within 30 days), of whom three died. Three and 6 months postoperatively, pulmonary function tests and VO2max were repeated. In the 22 survivors, the observed values were then compared with the predicted values. At 3 months, there were excellent correlations (absolute/predicted values): for FEV1r = 0.78 and 0.81; for DLCOr = 0.77 and 0.74; and for VO2max r = 0.71 and 0.83. The means of FEV1 and VO2max did not differ from the predicted values, whereas the predicted DLCO was lower than the observed value (ml/min/mmHg: 15.1 vs 17.9; percent predicted: 59.6 vs 70.9) (p < 0.05). At 6 months, correlations remained very good for FEV1 (r = 0.81 and 0.84) and for DLCO (r = 0.76 and 0.74), but had decreased for VO2max to 0.56 and 0.65, respectively. All means were higher than predicted (p < 0.05) owing to recovery in the lobectomy group. Patients with postoperative complications (group B) had a lower preoperative VO2max in percent predicted (62.8 +/- 7.5% vs 84.6 +/- 19.7%) (p < 0.01) and also a lower VO2max-ppo (10.6 +/- 3.6 vs 14.8 +/- 3.5 ml/kg/min and 44.3 +/- 13.5 vs 68.0 +/- 20.7 percent predicted) (p < 0.05) than patients without complication (group A). AVO2max-ppo < 10/ml/kg/min was associated with a 100% mortality. Although FEV1-ppo and DLco-ppo were lower in group B the difference did not reach significance. We conclude that radionuclide-based calculations of postoperative VO2max are predictive of perioperative morbidity and mortality: a VO2max-ppo of < 10 ml/kg/min may indicate inoperability. Further, short-term postoperative performance is accurately predicted by FEV1-ppo and VO2max-ppo, but long-term function is underestimated after lobectomy.

Adult↗
PubMed1996

Introduction to different approaches to intrabronchial treatment.

The field of bronchoscopy has considerably expanded in recent years. The rigid and flexible bronchoscope are used both for diagnostic and increasingly for therapeutic procedures. For the therapeutic procedures, the term "interventional bronchoscopy" has been coined. Apart from the more traditional indications for interventional bronchoscopies, such as aspiration of secretions and removal of foreign bodies, the treatment of early lung cancer and of inoperable stenoses of the central airways - benign or malignant-has moved to the centre stage of interventional endoscopies. This review focuses on the technique and indication for the following procedures: dilatation, diathermy, cryotherapy, photodynamic therapy, laser resection, brachytherapy and the insertion of stents (endoprostheses).

Algorithms↗
PubMed1995

[Combination endobronchial and conventional therapy possibilities in inoperable central lung tumors].

Up to 85% of patients with bronchogenic carcinoma are inoperable at the time of diagnosis and treatment remains largely palliative. Prognosis depends on the clinical tumor stage. In non-small cell carcinoma the clinical stages (I-IV) are defined according to the TNM classification, whereas in small cell carcinoma limited disease is distinguished from extensive disease. Neither classification accurately takes endobronchial tumor spread into account. At the time of diagnosis up to 30% of all lung cancer patients present with central airway obstruction and clinical signs of dyspnea, atelectasis and pneumonia. Most patients with central airway stenosis have inoperable tumors (stage IIIb and IV) and have until recently undergone conventional treatment consisting exclusively of chemo- and radiotherapy. Currently the best results are obtained with combined chemoradiotherapy. The rapid developments in the area of endobronchial treatment modalities enable us to relieve bronchial obstructions fast and safely. This achieves immediate symptomatic relief which in many cases is a precondition for starting chemo- or radiotherapy. Successful reopening of a major airway helps to prolong local tumor control and thus survival. Patients with inoperable lung cancer and obstruction of central airways should undergo initial endobronchial therapy followed by conventional chemo-radiotherapy.

Antineoplastic Agents↗
PubMed1995

Treatment of malignant obstruction of the superior vena cava with the self-expanding Wallstent.

BACKGROUND: Obstruction of the superior vena cava (SVC) in malignant disease can cause considerable distress to patients. Symptomatic relief can be achieved by the percutaneous implantation of a self-expanding stent (Wallstent) into the stenosis. METHODS: Fourteen patients with obstruction of the SVC were treated with one to three Wallstent endoprostheses. They suffered from advanced bronchogenic carcinoma (n = 12), thyroid carcinoma (n = 1), and breast carcinoma (n = 1). The indication for stent placement was symptomatic obstruction of the SVC and incurable disease. Stenting was performed for symptom relief, and before, during, and after courses of radiotherapy or chemotherapy as needed. RESULTS: Twelve patients experienced complete symptomatic relief within two days of stent placement. Two patients did not benefit. Three patients not given anticoagulation developed stent thrombosis between one week and eight months after initial placement, and within one day of endobronchial stent implantation with bronchial laser therapy or balloon dilatation in all three. Patency of the SVC was achieved again by a repeat procedure. CONCLUSIONS: Stent placement for obstruction of the SVC gives rapid symptomatic relief. Subsequent endobronchial stent implantation with bronchial laser therapy or balloon dilatation could be a risk for caval stent occlusion. Stent thrombosis remains a problem in patients who are not anticoagulated.

Aged↗
PubMed1995

Exercise capacity as a predictor of postoperative complications in lung resection candidates.

Exercise testing with measurement of maximal oxygen uptake (VO2max) is increasingly used in the assessment of lung resection candidates, but its predictive value for postoperative complications remains controversial. We therefore sought to determine the prognostic value of VO2max compared with other pulmonary function tests. A consecutive group of 80 patients (mean age 61 yr; 57 males and 23 females) scheduled for lung resection (62 malignancies, 12 benign disorders, and 6 carcinoids) underwent pulmonary function tests and symptom-limited cycle ergometry. All patients underwent lung resections: 21 pneumonectomies, 45 lobectomies, and 14 segmental or wedge resections. Group A (64 patients, 80%) had an uneventful postoperative course, whereas Group B (16 patients, 20%) had complications; 3 of them died (4% overall mortality rate). In a stepwise logistic regression analysis used to determine independent risk factors for postoperative complications (within 30 d), VO2max expressed as a percentage of predicted (84 +/- 19 for Group A versus 61 +/- 11 for Group B) proved to be the best predictor (predictive value 85.5%). Although VO2max expressed in absolute values (ml/kg/min) was also highly predictive (79.5%), a ROC curve analysis proved the percentage predicted values to be significantly more sensitive. Of 9 patients with a VO2max < 60% of predicted, 8 had complications, including all 3 patients who died after resections of more than one lobe (sensitivity 50%, specificity 98%). The estimated probability (probit model SAS software package) of suffering no complication was 0.9 for VO2max > 75% of predicted and 0.1 for a VO2max < 43%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Lung scanning and exercise testing for the prediction of postoperative performance in lung resection candidates at increased risk for complications.

OBJECTIVE: To analyze the value of preoperative lung scanning and exercise testing for the prediction of postoperative complications and of the short- as well as long-term performance in lung resection candidates at increased risk for complications. DESIGN: Prospective clinical trial. SETTING: Clinical pulmonary function laboratory in a university teaching hospital. PATIENTS: Twenty-five (mean age, 63 years; 17 men) of 84 consecutive lung resection candidates were considered at increased risk for postoperative complications due to impaired pulmonary function (FEV1 < 2 L or diffusion of carbon monoxide [DCO] < 50% predicted, or FEV1 and DCO < or = 80% predicted combined with New York Heart Association dyspnea index > or = 2). INTERVENTIONS: Candidates underwent radionuclide ventilation/perfusion scans and exercise testing to predict postoperative (= ppo) values for FEV1, DCO, and maximal O2 uptake (VO2max). They all underwent thoracotomy for neoplastic lesions; 7 had pneumonectomies, 18 lobectomies. Six patients had postoperative complications (within 30 days), of whom three died. Three and 6 months postoperatively, pulmonary function tests and VO2max were repeated. MEASUREMENTS AND RESULTS: In the 22 survivors, the observed values were then compared with the predicted values. At 3 months, there were excellent correlations (absolute/predicted values): for FEV1 r = 0.78 and 0.81; for DCO, r = 0.77 and 0.74; and for VO2max, r = 0.71 and 0.83. The means of FEV1 and VO2max did not differ from the predicted values, whereas the predicted DCO was lower than the observed value (mL/min/mm Hg: 15.1 vs 17.9; percent predicted: 59.6 vs 70.9) (p < 0.05). At 6 months, correlations remained very good for FEV1 (r = 0.81 and 0.84) and for DCO (r = 0.76 and 0.74), but had decreased for VO2max to 0.56 and 0.65, respectively. All means were higher than predicted (p < 0.05) owing to recovery in the lobectomy group. Patients with postoperative complications (group B) had a lower preoperative VO2max in percent predicted (62.8 +/- 7.5% vs 84.6 +/- 19.7%) (p < 0.01) and also a lower VO2max-ppo (10.6 +/- 3.6 vs 14.8 +/- 3.5 mL/kg/min and 44.3 +/- 13.5 vs 68.0 +/- 20.7% predicted) (p < 0.05) than patients without complications (group A). A VO2max-ppo < 10 mL/kg/min was associated with a 100% mortality. Although FEV1-ppo and DCO-ppo were lower in group B, the difference did not reach significance. CONCLUSIONS: Radionuclide-based calculations of postoperative VO2max are predictive of operative morbidity and mortality: a VO2max-ppo of < 10 mL/kg/min may indicate inoperability. Further, short-term postoperative performance is accurately predicted by FEV1-ppo and VO2max-ppo, but long-term function is underestimated after lobectomy.

Aged↗
PubMed1995

[Strategy for staging non-small cell bronchial carcinoma (NSCLC) with special reference to imaging procedures].

Imaging methods, especially CT and for specific questions MRI, are an essential part of diagnosis and staging of non-small cell lung cancer. They are effective methods for the detection of unresectable tumours and avoid the necessity for further invasive examinations and explorative thoracotomies. The judgement of lymph node size by CT suffers from a limited accuracy. Nevertheless, it allows guided bronchoscopical staging biopsies of enlarged mediastinal lymph nodes (> 1 cm) and, therefore, a selective indication of mediastinoscopy. CT scans of the thorax usually are extended to the adrenal glands and the liver to exclude metastasis. Extrathoracic scanning beyond the upper abdomen and bone scintigraphy should be restricted to patients with clinical indicators or symptoms. The combined application of imaging methods, bronchoscopy, and mediastinoscopy provides better selection of surgical candidates and hence reduces the rate of unresectable operations.

Bronchoscopy↗
PubMed1994

[Interventional bronchoscopy].

The field of bronchoscopy has considerably expanded in recent years. The rigid and flexible bronchoscope are both used for diagnostic and increasingly for therapeutic procedures; for the therapeutic procedures the term 'interventional bronchoscopy' has been coined. Apart from the more traditional indications for interventional bronchoscopies, such as aspiration of secretions and removal of foreign bodies, the treatment of inoperable stenoses of the central airways--benign or malignant--has moved to the center stage of interventional endoscopies. This review focuses on the technique and indication of the following procedures: bronchial toilette, foreign body removal, dilatation, diathermy, cryotherapy, photodynamic therapy, laser resection, brachytherapy and the insertion of stents (endoprostheses).

Airway Obstruction↗
PubMed1994

Evaluation of high-risk lung resection candidates: pulmonary haemodynamics versus exercise testing. A series of five patients.

We compared the value of exercise testing and measurement of pulmonary haemodynamics (PH) in the pre-operative assessment of 5 patients (mean age: 64 years, 3 men) with clinical stage I or II bronchogenic carcinoma and severe chronic obstructive pulmonary disease. They were considered at high risk due to poor pulmonary function tests (PFT); (one or more of the following): (1) radionuclide calculated postlobectomy FEV1 < 30% predicted, (2) diffusion capacity or transfer factor < 60% predicted, combined with a fall in PaO2 on maximal exercise of > 5 mm Hg, (3) a PaCO2 at rest of > 45 mm Hg. Maximal oxygen uptake (VO2max) during symptom-limited cycle ergometry and PH were measured in these 5 patients. They were considered eligible for lobectomy if they fulfilled at least one of the two criteria: (1) mean pulmonary artery pressure (PAP) of < 35 mm Hg and pulmonary vascular resistance of < 190 dyn.s.cm-5 at moderate exercise (40 W), (2) a VO2max of > or = 15 ml/kg/min. Six months postoperatively PFT and VO2max were measured again. PAP40W was 21, 38, 38, 46 and 52 mm Hg, respectively, which would have excluded 4/5 patients from surgery. VO2max was 21.7, 14.9, 13.4, 19.2 and 18.6 ml/kg/min, respectively, which would have excluded 2/5 patients. Expressed in percent predicted, however, VO2max was > or = 69% in all 5 patients, indicating only mild impairment of exercise capacity in the 2 patients with < 15 ml/kg/min VO2max. Therefore all 5 patients were offered surgery and underwent lobectomy. Apart from 1 prolonged air leak no complications occurred, the mean hospital stay was 16 days (13-21).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

[Special endobronchial palliative measures].

Inoperable pulmonary malignancies can present with local stenoses of the central airways either at the time of diagnosis or later on. Depending on their localization, these obstructions cause progressive dyspnea, postobstructive atelectasis and/or pneumonia. The patient's general condition will deteriorate, and at the tracheal level life-threatening dyspnea can develop. If central airways stenosis is suspected, fiberbronchoscopy is mandatory to decide whether local endobronchial palliation is a feasible treatment modality. Usually, local palliation is combined with chemo-and/or radiotherapy. Laser resection using the Nd-YAG laser is performed for obstructions caused by endoluminal tumour growth and leads to an immediate effect after a single session. Brachytherapy means local, endobronchial irradiation with a short depth of penetration. The active probe is placed with the aid of the fiberbronchoscope. Brachytherapy can be used alone, but is often combined with an initial laser resection for the consolidation of the treatment effect. The principal of photodynamic therapy consists of photosensitization of tumour cells followed by local laser light application which leads to cell death. In selected cases this treatment can be curative. Extrinsic stenoses which are caused by external compression of the airways or by thickening of the airway walls through submucosal tumour spread must be treated by dilatation and insertion of stents (endoprostheses) to maintain airway patency. These stents--mostly self-expanding silicone or metal devices--are usually inserted with the rigid bronchoscope. Again, endobronchial and/or percutaneous radiotherapy is added to obtain longer local tumour control.

Airway Obstruction↗
PubMed1994

Bronchoprotection by salmeterol: cell stabilization or functional antagonism? Comparative effects on histamine- and AMP-induced bronchoconstriction.

Salmeterol provides bronchoprotection against a number of constrictor stimuli for more than 12 h after a single dose. This effect could be due either to functional antagonism at the level of airway smooth muscle or to cell-stabilizing effects of the compound. In this study, we attempted to clarify this mechanism by comparing the effects of salmeterol (50 micrograms), salbutamol (200 micrograms) and placebo on the airway responsiveness to histamine (to assess functional antagonism), and to adenosine 5'-monophosphate (AMP) (to assess additional cell-stabilizing effects), 14 h after drug treatment. Thirteen patients with mild allergic asthma were studied in a double-blind, randomized protocol on 6 days, at least 48 h apart. Forced expiratory volume in one second (FEV1) was measured before and 15 min after inhalation of the study medication. Then, 14 h later (8 a.m. the following morning), a bronchoprovocation test with histamine or AMP was performed. We found that 14 h after inhalation, salmeterol still had a significant effect on FEV1 in comparison to placebo and salbutamol. The provocative dose producing a 20% fall in FEV1 (PD20histamine) was significantly increased after salmeterol, whilst the increase in PD20AMP did not reach significance. The shift in PD20 (in doubling dose steps) induced by salmeterol pretreatment was not different between histamine and AMP. We conclude that the prolonged protective effect of salmeterol occurs via an extended bronchodilating and functional antagonistic action and not via a cell-stabilizing effect.

Adenosine Monophosphate↗
PubMed1994

Pulmonary oedema and hypotension induced by hydrochlorothiazide.

We present the case of a patient with acute onset of dyspnoea after a long-distance flight. Pulmonary embolism was suspected, but could be excluded by perfusion scintigraphy. The electrocardiogram and chest X-ray were compatible with acute myocardial infarction and pulmonary oedema, but the slightness of the elevation of pulmonary capillary wedge pressure allowed cardiogenic pulmonary oedema to be excluded. The clinical picture was then interpreted as pneumonia with sepsis and hypotension. The rapid and full clinical recovery within 48 h, together with the close temporal relationship of ingestion of hydrochlorothiazide and the onset of symptoms, allowed the diagnosis of drug-induced pulmonary oedema and anaphylactoid hypotension.

Anaphylaxis↗