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Biomedical subjects

H Toomes

Publications and source records attributed to H Toomes.

At least 55 records · Page 3Linked to original sources
PubMed1990

[Unilateral lung transplantation--an initial report of experiences].

Lung transplants have been attempted since 1963 but with little success. After fundamental work by the Toronto group with improved surgical techniques and after the introduction of cyclosporin that group was able to present convincing results. Of 16 unilaterally transplanted patients with pulmonary fibrosis in the final stage, 10 are still living, one of them for now 5 years. With bilateral lung transplantation the indication was extended to cover further pulmonary diseases in the final stage, such as emphysema, bronchiectases, eosinophilic granuloma, primary pulmonary hypertension and bronchiolitis obliterans. The unilateral lung transplantation performed by us failed after initially excellent functioning, on the 9th postoperative day because of a Pseudomonas infection that had been transferred with the donor organ.

Adult↗
PubMed1989

Bilobectomy in a 90-year-old patient.

A 90-year-old patient was admitted to our clinic after two weeks of dangerously increasing hemoptysis. Bronchoscopy showed the segment bronchi of the right lower lobe to be subtotally occluded by a tumour. A biopsy was not taken because of simultaneous bleeding. After weighing the risks, surgery was decided on despite the advanced age of the patient. The centralized position of the tumour necessitated a bilobectomy. Histology showed a small-cell bronchial carcinoma T2N1M0. After initial secretion retention and mild transitional syndrome, the postoperative course was uncomplicated. Four weeks after surgery, the patient could be transferred to his local hospital where he was discharged home after a further two months. There was no reappearance of hemoptysis. At the last check-up, one year postoperatively, there was no tumour recurrence. The patient lives alone in his flat as prior to surgery. This case shows that, in individual patients, larger pulmonary resections are also possible and justified in the tenth decade of life.

Aged↗
PubMed1989

Mucociliary clearance following tracheal resection and end-to-end anastomosis.

Mucociliary clearance is an important cleaning system of the bronchial tree. The complex transport system reacts sensitively to medicinal stimuli and inhaled substances. A disturbance causes secretion retention which encourages the development of acute and chronic pulmonary diseases. It is not yet known in which way sectional resection of the central airway effects mucociliary clearance. A large number of the surgical failures are attributable to septic complications in the area of the anastomosis. In order to study the transportation process over the anastomosis, ten dogs underwent a tracheal resection with end-to-end anastomosis, and the mucociliary activity was recorded using a bronchoscopic video-technical method. Recommencement of mucous transport was observed on the third, and transport over the anastomosis from the sixth to tenth, postoperative days. The mucociliary clearance had completely recovered on the twenty-first day in the majority of dogs. Histological examination of the anastomoses nine months postoperatively showed a flat substitute epithelium without cilia-bearing cells in all dogs. This contrasts with the quick restitution of the transport function. In case of undamaged respiratory mucosa, a good adaptation of the resection margins suffices for the mucous film to slide over the anastomosis.

Anastomosis, Surgical↗
PubMed1989

[Functional aspects of pleural empyema and pleural induration].

Decortication for pleural empyema with or without residual cavities was performed in 161 patients. Indications were sanitation of infection sites and improvement of respiratory function. A total of 73.3% of the patients had a non-specific and 22.4% a tuberculous empyema. Postoperative complications included 8.7% wound infections and 1.2% recurring empyema. Operative mortality was 0.6%. To estimate pulmonary function, the preoperative values of blood gas analysis and vital capacity were assessed in 75 patients and compared with those obtained after one year. A relatively slight improvement was seen only in those patients who had a preoperative reduction of vital capacity amounting to more than 40%. An indication for decortication solely to improve pulmonary function is rare. As a rule decortication is indicated for the simultaneous removal of septic foci and functional improvement.

Adult↗
PubMed1987

[Chest wall replacement with resorbable synthetic mesh].

The dreaded thoracic wall instability occurring after chest wall resection can be avoided with the use of modern synthetic materials. Extensive resections which are sometimes necessary, especially in the field of tumor surgery on curative or palliative grounds, are possible without significantly affecting thoracic wall function. The use of absorbable mesh has further increased the range of application. Thoracic wall resection and reconstruction can also be carried out in primary infected regions. The indications and operative procedures are presented based on 47 cases.

Adult↗
PubMed1987

Analysis of adenomatous structures in histopathology.

A new idea of structure analysis in histopathology based upon first-order and third-order structures is presented. Networks formed by single cells and by tubulopapillary formations in adenomatous tissue were analyzed. The algorithm applied is based on the neighborhood conditions defined by O'Callaghan, using graph theory procedures. Twenty cases each of healthy colon mucosa, tubulovillous adenomas and highly to moderately differentiated adenocarcinomas of colon plus ten cases of mesotheliomas and ten cases of adenocarcinomas metastatic to the pleura were analyzed. Statistically significant differences were found in the cyclomatic number of neighboring elements. Classification of specimens of colon mucosa using discriminant analysis yielded correct results in 85% of the 20 cases. All ten cases of metastatic adenocarcinoma and nine of the ten cases of mesothelioma were also correctly classified by the same procedure. A trial of prospective diagnostic assistance in routine histology based upon these cases gave correct classification of three mesotheliomas and of two adenocarcinomas. The procedures are now being used successfully in the routine diagnosis of pleural epithelial/biphasic mesothelioma and of pleuritis carcinomatosa.

Adenocarcinoma↗
PubMed1986

Results of surgical treatment for pulmonary metastases.

One hundred and fifty-seven patients underwent surgery for pulmonary metastases in our hospital between 1977 and 1985. Potentially curative surgery was possible in 96 cases. We recorded survival rates of 60% after 3 years and 43% after 5 years. The median survival time was 47 months. When compared to radical surgery, the 5-year survival rate for patients treated by palliative operations was less than 6%. The preoperative diagnostic examinations do not permit an exact determination of the number of metastases and their localization. When comparing the suspected number of metastases with the number determined during surgery using sternotomy we found an underestimate in 40% of the patients with suspected solitary metastasis and in 85% of the patients with multiple metastases. We therefore recommend median sternotomy with exploration of both pleural cavities and lungs as standard access also for patients with suspected solitary metastasis.

Adolescent↗
PubMed1985

Assay for the determination of human carcinoma cells in circulating blood.

Methods have been developed in an in vitro system (1) of assessing the number of disseminated tumor cells in peripheral blood and (2) of enriching tumor cells from peripheral blood samples for further characterization. Cells from three human carcinoma lines (E 14, ChaGo, and LEDWiDr) were mixed with leukocytes from normal individuals in various ratios. The proportions of tumor cells were determined by a quantitative assay using 3H-thymidine, 3H-leucine, and 3H-galactose incorporation. Determination of tumor cell proportions with this method was most accurate in the range of 5 X 10(4) to 5 X 10(3) tumor cells mixed with a constant number (5 X 10(5] of lymphocytes. It was possible to separate 75Se-labeled tumor cells from 51Cr-labeled blood leukocytes by centrifugation in isopyknic Percoll density gradients. These cells were mixed at different ratios and subjected to Percoll gradient centrifugation. By this approach as few as 5 X 10(3) tumor cells could by identified in the presence of 5 X 10(7) leukocytes, representing a ratio of 1: 10,000. Percoll centrifugation did not damage the tumor cells. In blood cells from two lung cancer patients with lung metastases the incorporation of 3H-thymidine and 3H-galactose was significantly enhanced compared with that in blood cells from patients with primary lung tumors and in cells from normal individuals. This difference became even more apparent when metabolically-labeled blood cells were subsequently separated by Percoll gradient centrifugation.

Adult↗
PubMed1985

Tumour volume and macroscopic growth pattern of bronchogenic carcinoma.

126 resected malignant lung tumours were cut into serial sections. The tumour volume, the pTN-stage and the macroscopic growth pattern were computed. The average tumour volume was found to be 28.5-35.8 cm3 (confidence limits, p greater than or equal to 95%) and to be independent of the major cell type of the carcinomas. The cell types grow in different macroscopically distinguishable tumour growth patterns: epidermoid carcinomas grow mostly in bizarre finger-like shapes and small cell anaplastic and adenocarcinomas more frequently in ball-like shapes. The different growth patterns depend on the cell type, the cellular response of the host tissue and the tumour volume. Due to irregular growth pattern the tumour volume computed by X-ray diameter is likely to be overestimated by 50%-300%.

Adenocarcinoma↗
PubMed1985

Tracheal resection--state of the art.

Sleeve resection of the trachea and reconstruction by end-to-end anastomosis is seen as the method of choice in the treatment of short and long stenoses of the trachea following long-term artificial respiration and tumors. The experience with tracheal resection in 73 patients operated upon at 2 different thoracic units is analyzed. Postintubation was the main indication for operation in 63% of the patient population. The 30-day postoperative mortality rate was 8% with a total mortality of 19%. A satisfactory functional result was attained in 73% of the patients operated upon including those with malignant tumors. Restenoses occurred in 6 of the 73 patients who underwent surgery. Different approaches to tracheal resection were chosen in the 2 clinics and the possibility of mobilizing the larynx was used in a different way. A preference for resorbable material was noted regardless of the operative technique and has prevented restenosis. The diagnostic procedures considered mandatory, the indications for surgery and the various operative techniques are discussed.

Humans↗
PubMed1985

Experiences with prosthetic reconstruction of the trachea and bifurcation.

Extensive tracheal resections were performed to avoid imminent asphyxia in nine patients. Airway continuity was restored with either a straight or a bifurcated Neville prosthesis. One patient had progressive perichondritis and the remaining eight had advanced malignancy. Three patients died of complications due to the prosthesis, 15 days, seven months, and 10 months after operation. Five patients from their underlying disease and one patient is alive 13 months after reconstruction.

Adult↗