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Biomedical subjects

H B Ris

Publications and source records attributed to H B Ris.

At least 19 recordsLinked to original sources
PubMed1999

[Pulmonary abscesses and bronchiectasis].

Both primary and secondary pulmonary abscesses are increasingly observed in thoracic surgery units. Primary pulmonary abscesses are related to necrotising pneumonia or aspiration due to alcoholism, drug abuse, dysphagia or gastrointestinal reflux disease. Secondary poststenotic abscesses are related to bronchial obstruction (endobronchial tumour or foreign body aspiration) or to superinfection of pulmonary neoplasia or infarction pneumonia. Bronchoscopy is mandatory if a pulmonary abscess is suspected, to exclude endobronchial obstruction and obtain bacteriological examination by bronchial lavage or transbronchial fine needle aspiration. Transthoracic fine needle aspiration may be helpful for bacteriological examination, since germs found in sputum do not necessarily correlate with those found in the abscess. Pulmonary abscesses are primarily treated by administration of appropriate antibiotics with a remission rate of 80%. In the presence of complications of the abscess or if conservative management fails, percutaneous transthoracic drainage or surgical resection may be indicated. Bronchiectasis is also increasingly seen, especially in refugees and immigrants. The disease is characterised by chronic dilatation of bronchi with paroxysmal cough, mucopurulent secretion and recurrent pulmonary infections. Bronchiectasis is most commonly caused by recurrent bronchial infections during childhood or behind bronchial obstruction. Congenital bronchiectasis is very rare. Viral and bacterial pulmonary infections during childhood are by far the most common causes of bronchiectasis, leading to destruction of the mucociliary apparatus and the cartilage of the segmental bronchi. Bronchiectasis should be treated by an appropriate antibiotic regimen. Resection should only be considered in situations where a conservative regimen fails. Segmentectomy of all involved segments is the surgical treatment of choice in situations with well-localised bronchiectasis and results in long-lasting remission in over 80% of those patients. Patients with bilateral bronchiectasis may be considered for bilateral surgical resection if diffuse and congenital disease has been ruled out.

Adult↗
PubMed1999

Morbidity and validity of the hemiclamshell approach for thoracic surgery.

OBJECTIVE: This is a prospective study to evaluate the indications and outcome of the hemiclamshell incision (longitudinal partial sternotomy combined with an antero-lateral thoracotomy) as used for a consecutive series of patients requiring surgery for various thoracic pathologies not ideally approached by postero-lateral thoracotomy, sternotomy or thoracoscopy. METHODS: All patients with a hemiclamshell incision performed between 1994 and 1998 were prospectively analyzed regarding indications, postoperative morbidity and outcome (clinical examination and pulmonary function testing) in order to validate this incision for thoracic surgery. RESULTS: 25 patients (15 men, 10 women) with an age ranging from 16 to 73 years (mean 43 years) underwent a hemiclamshell incision. The indications for the hemiclamshell approach were (1) chest trauma with massive hemorrhage requiring urgent access to the mediastinum and the ipsilateral pleural space (40%), (2) tumors of the anterior cervico-thoracic junction with suspicion of vascular involvement (28%) and (3) lesions involving both one chest cavity and the mediastinum (32%). The 30-day mortality was 8%. One patient suffered a sternal wound infection, mediastinitis and pleural empyema after a gun shot wound, whereas wound healing was uneventful in all other patients. Analgesic requirements for postoperative pain relief were not increased as compared to those following a standard thoracotomy. At 3 months normal sensitivity of the entire chest wall and intact shoulder girdle function was noted in 90% of the patients. Pulmonary function testing showed no restriction due to the hemiclamshell incision. CONCLUSIONS: The hemiclamshell incision is a useful approach in selected patients and does not cause more morbidity or long-term sequelae than a standard thoracotomy.

Adolescent↗
PubMed1999

Photodynamic therapy with mTHPC and polyethylene glycol-derived mTHPC: a comparative study on human tumour xenografts.

The photosensitizing properties of m-tetrahydroxyphenylchlorin (mTHPC) and polyethylene glycol-derivatized mTHPC (pegylated mTHPC) were compared in nude mice bearing human malignant mesothelioma, squamous cell carcinoma and adenocarcinoma xenografts. Laser light (20 J/cm2) at 652 nm was delivered to the tumour (surface irradiance) and to an equal-sized area of the hind leg of the animals after i.p. administration of 0.1 mg/kg body weight mTHPC and an equimolar dose of pegylated mTHPC, respectively. The extent of tumour necrosis and normal tissue injury was assessed by histology. Both mTHPC and pegylated mTHPC catalyse photosensitized necrosis in mesothelioma xenografts at drug-light intervals of 1-4 days. The onset of action of pegylated mTHPC seemed slower but significantly exceeds that of mTHPC by days 3 and 4 with the greatest difference being noted at day 4. Pegylated mTHPC also induced significantly larger photonecrosis than mTHPC in squamous cell xenografts but not in adenocarcinoma at day 4, where mTHPC showed greatest activity. The degree of necrosis induced by pegylated mTHPC was the same for all three xenografts. mTHPC led to necrosis of skin and underlying muscle at a drug-light interval of 1 day but minor histological changes only at drug-light intervals from 2-4 days. In contrast, pegylated mTHPC did not result in histologically detectable changes in normal tissues under the same treatment conditions at any drug-light interval assessed. In this study, pegylated mTHPC had advantages as a photosensitizer compared to mTHPC. Tissue concentrations of mTHPC and pegylated mTHPC were measured by high-performance liquid chromatography in non-irradiated animals 4 days after administration. There was no significant difference in tumour uptake between the two sensitizers in mesothelioma, adenocarcinoma and squamous cell carcinoma xenografts. Tissue concentration measurements were of limited use for predicting photosensitization in this model.

Adenocarcinoma↗
PubMed1999

Is the function of the serratus anterior muscle disturbed following division during a standard thoracotomy?

In a prospective study the functional results after dissection or preservation of the serratus anterior muscle in the postero-lateral standard thoracotomy were evaluated. In 14 patients of our clinic with dissection and suture and in 14 patients with preservation of the serratus muscle the muscle function was assessed and compared preoperatively, within the first two post-operative weeks, and three months after the operation by the same physiotherapists. The two groups were blinded in regard to age, original disease, and mode of intervention. We compared the wing position of the scapula in the sitting position and the positioning of the scapula at fixation of the shoulder joint in the sitting and in the supine position. Using a four-grade function assessment scheme, both groups obtained the same functional results. There was no seroma in either group. After 2.8 (2.5 to 3.0) years all the surviving patients described symmetric functional conditions. We therefore conclude that in order to achieve a better view of the operative field the serratus muscle may be dissected close to the origin if it is then readapted.

Adult↗
PubMed1999

Selective use of temporary intravascular shunts in coincident vascular and orthopedic upper and lower limb trauma.

BACKGROUND: Combined vascular and skeletal injuries are associated with a high limb loss rate. One of the major factors resulting in amputation is frequently because the allowable warm ischemia time for skeletal muscle is exceeded before adequate revascularization. METHODS: Temporary vascular shunting has been used in selected patients with complete ischemia to minimize the ischemic time of the injured limb, allowing identification of vital structures, thorough debridement, and rigid internal fixation before definitive vascular repair. RESULTS: Five male and two female patients with a median age of 46 years (range, 27-76 years) admitted with combined orthopedic and vascular injuries of the upper limbs in four and the lower limbs in three patients underwent primary vascular shunting. The median ischemic time for all patients was 180 minutes (range, 120-210 minutes). Shunt insertion was accomplished in all cases within 30 minutes. Median dwell time for the shunt was 185 minutes (range, 90-390 minutes). No shunt-related complications or limb loss occurred. During follow-up ranging from 2 to 24 months, all vascular repairs remained patent. All fractures healed primarily, except for one patient in whom a necrosis of the humeral head occurred. Five patients had an excellent and two patients a good result. CONCLUSION: Initial temporary vascular shunting in selected patients with combined skeletal and vascular injury of the upper or lower limb may reduce the complications resulting from prolonged ischemia and permits an unhurried and reasonable sequence of treatment.

Adult↗
PubMed1998

Photosensitizing effects of m-tetrahydroxyphenylchlorin on human tumor xenografts: correlation with sensitizer uptake, tumor doubling time and tumor histology.

The photodynamic effects of m-tetrahydroxyphenylchlorin (mTHPC) were assessed on human malignant mesothelioma, squamous cell carcinoma and adenocarcinoma xenografts grown in nude mice and were correlated with mTHPC uptake, histology and doubling time of the tumors. Non-thermal laser light was delivered to the tumor as surface radiation 4 days after intraperitoneal administration of 0.1 and 0.3 mg mTHPC/kg body weight, respectively. The extent of tumor necrosis was measured by histomorphometry. The mTHPC concentration in non-irradiated tumors was assessed by high-performance liquid chromatography (HPLC). The tumors were graded according to their doubling time and their vascular architecture as assessed by histology. The 0.1 mg/kg dose of mTHPC resulted in an equal uptake for all 3 tumor types but revealed a larger extent of photosensitized necrosis for adenocarcinoma, which displayed a delicate tumor stroma with numerous small capillary vessels, than for mesothelioma and squamous cell carcinoma, which were both poor in stroma and vessels. The 0.3 mg/kg dose of mTHPC resulted in a 2-fold higher tumor uptake for all 3 tumor types and in a larger extent of necrosis for mesothelioma and squamous cell carcinoma, but not for adenocarcinoma xenografts, compared with the lower drug dose. Our results demonstrate that different tumor xenografts respond differently to mTHPC-PDT for a given drug-light condition. In this setting, the photosensitizing effect was more closely related to the vascular architecture of the tumors than to the sensitizer uptake and doubling time of the different tumors

Adenocarcinoma↗
PubMed1998

Endobronchial photodynamic therapy: comparison of mTHPC and polyethylene glycol-derived mTHPC on human tumor xenografts and tumor-free bronchi of minipigs.

BACKGROUND AND OBJECTIVE: Photodynamic therapy (PDT) with mTHPC and polyethylene glycol-derived mTHPC (pegylated mTHPC) was compared on nude mice bearing human squamous cell carcinoma and adenocarcinoma xenografts. The same treatment regimens were applied to the bronchi of tumor-free minipigs to assess injury to normal tissue. STUDY DESIGN/MATERIALS AND METHODS: Laser light (652 nm, 20 J/cm2) was delivered as surface radiation to the xenografts 4 days after intraperitoneal administration of 0.1 mg/kg mTHPC or an equimolar dose of pegylated mTHPC, respectively. The extent of tumor necrosis was assessed by histomorphometry. Endobronchial PDT was performed on the bronchi of minipigs with the same drug and light doses at drug-light intervals ranging from 12-96 hr. RESULTS: Both sensitizers produced larger necrosis of squamous cell carcinoma and adenocarcinoma xenografts than was observed in untreated controls (P < 0.005). Pegylated mTHPC led to larger tumor necrosis than mTHPC in squamous cell carcinoma (P < 0.001), but not in adenocarcinoma xenografts. mTHPC-PDT resulted in ulceration and necrosis of bronchial mucosa in minipigs at drug-light intervals ranging from 12-48 hr, which was not observed after use of pegylated mTHPC. CONCLUSIONS: In this setting, pegylated mTHPC had advantages as a photosensitiser compared to mTHPC.

Adenocarcinoma↗
PubMed1998

Video-assisted thoracoscopic surgery for fibrinopurulent pleural empyema in 67 patients.

BACKGROUND: The roles of different drainage procedures in the management of empyema have to be redefined now that video-assisted thoracoscopic surgery (VATS) has been introduced. The debridement of fibrinopurulent stage II empyema with the use of VATS was assessed prospectively in regard to control of infection and restoration of pulmonary function. METHODS: Between January 1992 and May 1996, all patients at our institution with fibrinopurulent empyema that did not respond to chest tube drainage and antibiotic therapy were treated by debridement with the use of VATS. The patients were followed up prospectively by clinical and radiologic assessments 3 and 6 months after the operation and by spirometry 6 months after the operation. RESULTS: Video-assisted thoracoscopic surgery was initiated in 67 patients, but conversion to open decortication was required because of the finding of advanced disease in 19 patients (28%). Forty-eight patients underwent successful debridement with the use of VATS. The mean operative time was 82.1 minutes (range, 50 to 135 minutes), the mean duration of postoperative chest tube placement was 4.1 days (range, 2 to 8 days), and the mean duration of postoperative hospitalization was 12.3 days (range, 4 to 42 days). No wound infections were observed during the postoperative course. Both the 30-day mortality rate and the recurrence (ie, need for thoracotomy) rate were 4%. The mean predicted vital capacity was 84.8% +/- 14.9% and the mean predicted forced expiratory volume in 1 second was 88.6% +/- 19.2% 6 months after the operation. CONCLUSIONS: Debridement with the use of VATS is safe and efficient for stage II empyema, but open decortication should be used for more advanced disease.

Adult↗
PubMed1998

Isolated lung perfusion: single-pass system versus recirculating blood perfusion in pigs.

BACKGROUND: Cytostatic isolated lung perfusion has been advocated for treating pulmonary metastasis of soft tissue sarcoma. Different techniques of isolated lung perfusion have been developed. METHODS: Isolated lung perfusion with and without doxorubicin was performed on white pigs during 15 minutes either by a single-pass system (n = 7) or by a recirculating-blood perfusion system (n = 7). Three animals with endovenous drug application served as controls. Leakage was assessed using isotopic tracers. Perfusion-induced lung tissue injury was determined by postperfusion chest radiographs, by angiotensin-converting enzyme-to-protein ratio in the plasma and in the bronchioalveolar lavage fluid, and by wet-to-dry weight ratio and histologic examination of lung biopsy specimens at 20 and 50 minutes. Doxorubicin concentration in lung tissue and plasma was compared between the three study groups. RESULTS: All isolated lung perfusion studies were successfully performed without significant systemic leakage (< 0.6%). Wet-to-dry weight ratio was significantly lower after single-pass as compared with recirculating-blood perfusion and endovenous drug application at both time points (5.0 +/- 1.1 and 5.3 +/- 0.8 for single-pass versus 6.6 +/- 1.1 and 6.9 +/- 0.5 for recirculating-blood versus 6.6 +/- 0.2 and 5.9 +/- 0.7 for the control group, respectively; p < 0.05). Angiotensin-converting enzyme-to-protein plasma ratio in the single-pass group was significantly lower only at 20 minutes (6.3 +/- 2.4 versus 9.3 +/- 1.0 versus 9.7 +/- 1.9, respectively; p < 0.05) but not at 50 minutes. Angiotensin-converting enzyme-to-protein ratio in bronchoalveolar lavage fluid, histology of lung biopsy specimens, and chest radiographs did not differ significantly between the three groups. Doxorubicin lung tissue concentration was not significantly different after single-pass (17.5 micrograms/g) and recirculating-blood perfusion (21.9 micrograms/g), but was significantly higher than after endovenous drug application (3.0 micrograms/g; p < 0.01). CONCLUSIONS: Both isolated lung perfusion techniques resulted in a sixfold to sevenfold higher doxorubicin lung tissue concentration than after endovenous application. Isolated lung perfusion-induced lung injury was similar for both techniques, but recirculating-blood perfusion appeared to result in more acute lung injury and was technically more demanding than single-pass perfusion.

Animals↗
PubMed1998

Cytostatic lung perfusion by use of an endovascular blood flow occlusion technique.

BACKGROUND: Different modalities of cytostatic lung perfusion were compared regarding plasma and tissue drug concentrations to assess the efficacy of an endovascular blood flow occlusion technique. METHODS: A cytostatic lung perfusion study with doxorubicin hydrochloride was performed on large white pigs (n = 12). Plasma and tissue concentrations of doxorubicin were compared for isolated lung perfusion with open cannulation (ILP), blood flow occlusion perfusion with open cannulation of the pulmonary artery alone (BFO), and intravenous drug administration (i.v.). In a fourth group, thoracotomy-free BFO perfusion was performed by endovascular balloon catheterization of the pulmonary artery (endovascular BFO). The 3 animals in this group were used to compare the doxorubicin-perfused pulmonary tissue with the contralateral nonperfused lobes after 1 month. RESULTS: The mean lung tissue doxorubicin concentration at the end of perfusion was 19.8 +/- 1.6 microg/g after ILP, 27.6 +/- 2.2 microg/g after BFO (p = not significant), and 3.0 +/- 0.8 microg/g after i.v. perfusion (p < 0.01). Whereas doxorubicin was not detectable in the plasma in the ILP group, concentrations ranged from not detectable to 0.44 microg/mL in the BFO group and from 0.31 to 0.84 microg/mL in the i.v. group (p < 0.05). Mean myocardial tissue concentration was not significantly different after BFO than i.v. perfusion (1.1 +/- 0.5 microg/g and 1.8 +/- 0.1 microg/g, respectively). In the endovascular BFO group, balloon-blocked pulmonary artery perfusion was successfully performed in all animals, and after 1 month, lung tissue showed no cytostatic-induced histologic changes. CONCLUSIONS: Compared with ILP, BFO cytostatic lung perfusion produced an insignificantly higher lung-tissue concentration, corresponding to a sixfold to ninefold higher level than after i.v. perfusion. Plasma drug levels during BFO perfusion were lower than during i.v. perfusion. Endovascular BFO may be a promising technique for repeated cytostatic lung perfusion.

Animals↗
PubMed1998

Video-assisted thoracoscopic pericardial fenestration for loculated or recurrent effusions.

OBJECTIVE: The validity of video-assisted thoracoscopic pericardial fenestration was prospectively assessed for loculated effusions. effusions previously treated by percutaneous catheter manoeuvres and those with concurrent pleural diseases. METHODS: Inclusion criteria consisted of echocardiographically documented pericardial effusions requiring diagnosis or relief of symptoms and recurrent effusions after failed percutaneous drainage and balloon pericardiotomy. Pre-operative CT-scan was used to delineate additional pleural pathology and to determine the side of intervention. All patients were followed clinically and by echocardiographic examination 3 months post-operatively. RESULTS: Twenty-four patients underwent thoracoscopic pericardial fenestration with 11 patients (54%) being previously treated by percutaneous catheter drainage, balloon pericardiotomy or subxyphoidal fenestration. Pre-operative echocardiography revealed septation and loculation in 18 patients (72%). Additional pleural pathology was identified on CT scan in 12 patients (50%) and talc pleurodesis was performed in six patients, all suffering from malignant pleural effusion. The mean operation time was 45 min (range 30-60 min) with no complications being observed. All patients were followed 3 months post-operatively by clinical and echocardiographic examination; relief of symptoms was achieved in all patients but echocardiography showed a recurrence in one patient (4%). Another recurrence was found by echocardiography after a mean follow-up time of 33 months in the 12 patients suffering from a non-malignant pericardial effusion. No recurrence of pleural or pericardial effusion was observed in the subset of patients with talc pleurodesis. CONCLUSION: Video-assisted thoracoscopic pericardial fenestration is safe and effective for loculated pericardial effusions previously treated by percutaneous drainage manoeuvres and those with concomitant pleural disease.

Adolescent↗
PubMed1998

[Blunt thoracic trauma with hemorrhage into a mediastinal lymphangioma--case report].

We describe a young snowboarder suffering from dyspnea, chest pain and dysphagia following a blunt chest injury. These symptoms were caused by an accident-related hemorrhage within a preexisting lymphangioma of the right posterior mediastinum. At the same time a lymphangioma of the left anterior mediastinum was found. The lymphangioma of the posterior mediastinum was resected through a right posterolateral thoracotomy after thoracoscopy had demonstrated that a complete resection could not be performed on this way. The lymphangioma of the left side was resected 4 month later by a left-sided hemiclamshell approach due to its size and localisation. Complications arising from mediastinal lymphangioma are described as compression, infection, spontaneous bleeding, rupture and chylothorax. This is the first description of a posttraumatic, symptomatic hemorrhage within a mediastinal lymphangioma.

Adolescent↗
PubMed1998

[Surgical diagnosis and therapy in patients with mediastinal space-occupying lesions. A retrospective analysis of 223 intervention with special reference to long-term course].

UNLABELLED: The diagnostic and therapeutic approach in patients with mediastinal masses (MM) treated at our institute between 1983 and 1993 was retrospectively reviewed. METHODS AND MATERIAL: 193 patients with MM (105 males and 88 females, average age 53, ranging from 16-81) underwent 223 interventions. Staging mediastinoscopies in lung cancer patients were ruled out. Long-term follow-up data were available in 123 of 162 cases with neoplastic MM (average follow-up time 5.5 years). Of all 223 surgical interventions 143 were diagnostic (53 parasternal mediastinotomies, 78 mediastinoscopies and 8 thoracoscopies) and 80 therapeutic (46 sternotomies and 34 posterolateral and a second half). The analysed period was splitted up in a first half (1983-1987) and second half (1988-1993) to study an eventual trend in the management of MM. RESULTS: The most frequent diagnoses were: thymoma (21%), malignant lymphoma (18%) and mediastinal sarcoidosis (14%). 43% of the MM were localized in the anterior, 46% in the middle and 7% in the posterior mediastinum. Thoracic pain, cough and dyspnoea represented the most common symptoms, leading to an invasive diagnostic procedure. 25% of the patients had no symptoms. The mortality and morbidity rate of all interventions was 3.4% and 18.7% respectively and concerned almost nerval injuries and postoperative respiratory failure. The percentage of direct tumor excisions increased from 21% during the first half of the period to 40% during the second half of the period, whereas diagnostic surgical interventions decreased from 57% to 44%. The percentage of total excisions after previous surgical biopsies decreased from 22% to 16%. In spite of the introduction of high resolution CT scan and MRI techniques during this time period no significant change in the use of presurgical diagnostic procedures was obvious. Fine needle biopsies and bronchoscopies were performed less frequent in the second half in comparison to the first half (11%, 7%, 29%, 13% respectively). From 123 patients with neoplastic disease data were available for long-term results. 35 had benign and 83 malignant histologies, in five cases dignity was unclear. 54% of these patients were disease-free at follow-up time, 10% had local recurrency or distant metastasis and 37% died during the observed time period. CONCLUSIONS: Surgical biopsy seems to remain the most important investigation for a successful interdisciplinary approach to MM. Overall morbidity and mortality rate of mediastinal surgery might appear remarkable but has to be related to the favorous long-term results after different individual treatment modalities in patients with mediastinal masses.

Adolescent↗
PubMed1998

[Progress in surgical therapy of bronchus carcinoma].

Surgical progresses in the treatment of lung cancer are not only related to technical details of surgery itself, but rely much upon an interdisciplinary approach before and after the operation. This will improve patient selection, multimodality treatment concepts and morbidity and mortality with overall improvement of quality of life in these patients.

Carcinoma, Bronchogenic↗
PubMed1998

[Is preoperative chemotherapy in locally advanced non-small-cell bronchial carcinoma of value?].

Although surgeons are able to resect completely locally advanced non-small cell lung cancer with mediastinal lymph node involvement (stage IIIA), the majority of patients succumb from metastatic disease. Therefore, neoadjuvant therapy was introduced in the management of this disease in order to eradicate distant metastases at an early stage. Phase II trials with preoperative chemotherapy in stage IIIA patients have shown that the pathological response (amount of tumour necrosis) and the clearance of mediastinal lymph node correlate with a better survival and is the best predictor for eradication of distant metastases. Indeed, three small randomised phase III studies have demonstrated a survival advantage for preoperative chemotherapy compared to surgery alone. Further studies are required to determine the best neoadjuvant regimen inducing the largest amount of tumour necrosis.

Carcinoma, Non-Small-Cell Lung↗
PubMed1998

[Curative radiotherapy in locally advanced non-small-cell bronchial carcinoma (NSCLC)].

Radiation is a standard treatment for patients with locally advanced non-small cell lung cancer. Only 5% of patients are alive after 5 years. Improvement of local control and survival time have been yielded using knowledge in radiobiology and technical innovations, especially three dimensional planning on the basis of CT and MRI. Further improvement could be reached by performing combination of radio- and chemotherapy. However, the best sequence of chemo- and radiotherapy could not be defined yet.

Carcinoma, Bronchogenic↗