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Biomedical subjects

H Toomes

Publications and source records attributed to H Toomes.

At least 73 records · Page 4Linked to original sources
PubMed1984

[Postoperative immunostimulation in non-small-cell bronchial carcinoma. Outcome and complications].

In two prospective, randomized clinical studies Corynebacterium parvum (C.p.), BCG or 0.9% saline solution were injected intrapleurally once between the 6th and 12th postoperative day in 878 patients with resected, non-oatcell bronchial carcinoma (stage I and II). The rate of complications following C.p.-instillation (chest pain, fever) was relatively low compared to partially serious complications following injection of BCG, especially in patients who underwent pneumonectomy (21.8% empyema compared to 3.2% in the placebo group). After an average follow-up of 4.6 years in the first study, 110 of 207 C.p.-treated patients (53%) were dead compared to 82 of 198 in the placebo group (41%). The difference is statistically significant (P less than 0.02). In the second study, 79 out of 197 BCG-treated patients (40%) were dead after an average follow-up of 2.8 years compared to 71 out of 208 placebo-treated patients (34%). This difference is not statistically significant. From these data it is concluded that postoperative immunotherapy as performed in these studies is not only of no benefit to the patients, but might even be detrimental as a result of an increased posttherapeutic complication rate and a partially diminished expectation of life.

Carcinoma, Bronchogenic↗
PubMed1984

Treatment of multiple unilateral arteriovenous pulmonary fistulae by transection of the pulmonary artery.

Multiple arteriovenous fistulae of the entire left pulmonary lobe were found to be the cause of increasing cyanosis on exertion and hour-glass nails in a 19-year-old patient. The right-to-left shunt amounted to 16%. The 2 possible forms of treatment were embolization of the arteriovenous fistulae or pneumonectomy. The first procedure was unsuitable because of the diffuse spread of the fistulae. In order to avoid all the early and late complications associated with a pneumonectomy, an unusual method was adopted: The left pulmonary artery was transected and the lung was left in place as a "physiological filling". Both a subjective and objective improvement could already be seen in the immediate postoperative period. At the last follow-up examination, 16 months after the operation, this was still the case.

Adult↗
PubMed1984

[Contribution of computer tomography to the diagnosis of bronchial carcinoids].

The CT findings in 10 patients with carcinoid tumors of the lung (highly differentiated in 8 cases, undifferentiated in 2 cases) are reported. The tumors were located in the hilar region (n = 4), in the perihilar region (n = 3) and in the periphery of the lung (n = 3). Dystelectasis and atelectasis of the lung with poststenotic inflammation were found in 4 patients. Infiltrating tumor growth with lymph node metastases were detected only once; this tumor was not able to be differentiated from other malignant space occupying lesions. There were no reliable CT criteria for bronchial carcinoids. Compared to conventional radiography the CT examination has the following advantages: better demonstration of size and location of the tumor, and the exclusion of infiltrating tumor growth, enlarged lymph nodes and calcified lung nodules.

Adult↗
PubMed1983

The coin lesion of the lung. A review of 955 resected coin lesions.

The retrospective study of 955 coin lesions of the lung showed 49% to be malignant. The proportion of malignant lesions increased with age. In patients older than 60 years of age, 65% of the lesions were malignant; in this group, bronchogenic carcinoma was the most frequent lesion. The delay prior to resection was especially pronounced in both younger patients and in patients with smaller lesions.

Adolescent↗
PubMed1983

Sleeve resection of the bronchus and pulmonary artery for pulmonary lesions.

The tissue preserving resections for non-small-cell bronchial carcinoma were grouped into 3 main categories: I. bronchoplastic procedures, II. angioplastic procedures, and III. concomitant bronchoplastic and angioplastic procedures, and into the subgroups of standard and extended sleeve resections. The indications were: elderly patients, impaired respiratory reserve, limited tumor growth, and palliative surgery. The analysis of 229 cases yielded follow-up data in 192 cases. The estimated 5-year survival rates were 34% in category I, 19% in II, and 14% in III. The decreasing survival is due to greater tumor burden. The operative mortality rate was 8.9% in category I, and 17% in category III, and therefore comparable with standard or extended pneumonectomy respectively. Surgical techniques and postoperative complications are discussed.

Aged↗
PubMed1983

Decortication of the lung.

From 1972 to 1982, 161 patients underwent pleural decortication because of pleural callosity with or without empyemic residual cavities. Indications were: Sanitation of infection sites and improvement of respiratory function. Of the patients, 73.3% had non-specific and 22.4% tubercular empyema. Postoperative complications included 8.7% wound infections and 1.2% recurring empyema. Operative mortality was 1.2%. To estimate pulmonary function, the preoperative values of blood gas analysis, vital capacity, forced expiratory volume and maximal voluntary ventilation were assessed and compared with those obtained early postoperatively and after one year in 75 patients. The average values of these measurements showed no significant improvement in postoperative pulmonary function. A relatively slight improvement (mean 13.8%) showed only in those patients who had a preoperative reduction of vital capacity of more than 40%. The indication for decortication to improve pulmonary function alone is questionable. As a rule it is based upon 2 factors--both elimination of infectious foci and improving function.

Adolescent↗
PubMed1982

Sleeve resection of the bronchus and the pulmonary artery for pulmonary lesions.

The tissue preserving resections for non-small-cell bronchial carcinoma can be grouped into three main categories: I. bronchoplastic procedures, II. angioplastic procedures, and III. concomitant broncho- and angioplastic procedures, and into the subgroups, standard and extended sleeve resection. The indication are; elderly patients, impaired respiratory reserve, limited tumour growth, and palliative surgery. The analysis of 229 cases yielded follow-up data in 192. The estimated 5 year survival rate was 34 per cent, 19 per cent and 14 per cent in categories I, II and III, respectively. The decrease in survival was due to a greater tumour burden. The operative mortality rate was 8.9 per cent in category I and 17 per cent in category III, such being comparable with standard or extended pneumonectomy, respectively. Surgical techniques and postoperative complications are discussed.

Adult↗
PubMed1981

[Parenchyma-preserving resection techniques for bronchial carcinoma (author's transl)].

Parenchyma-preserving resection techniques are grouped into two categories: (1) Broncho- and angioplastic resections that help avoid pneumonectomy and (2) Wedge or segment resections that help avoid lobectomy. The indications are: (a) Elderly patients (70 years); (b) Impaired respiratory reserve; (c) Palliative surgery; (d) Limited tumour growth. The analysis of 288 relevant cases yielded follow-up data in 232 cases: Survival and mortality of group I operations are comparable to those after (extended) pneumonectomy; higher tumour stages prevailed in the combined plastic surgery subgroup. The data of group II are similar to those with lobectomy; the relatively high local recurrence rates render group II operation techniques unreliable until more data are available.

Carcinoma, Bronchogenic↗
PubMed1981

[Prosthetic replacement of the trachea by synthetics (author's transl)].

Long tracheostenosis especially when sharing the mediastinum should be treated by a team of ENT- and thoracic surgeons. In 14 cases we achieved good functional results by transverse resection and anastomosis of the trachea. Plastic surgery of the trachea is limited by the etiology and the length of the shared tracheo-bronchial area. Neville (1976) has experiences in prosthetic replacement by synthetics in 26 cases. In 4 cases of special and cautiously placed indication we used Neville-prosthesis. The indications, the problems and the results are reported.

Humans↗