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L Kotsis

Publications and source records attributed to L Kotsis.

At least 19 recordsLinked to original sources
PubMed2001

Bilateral bronchial stenting and esophageal intubation for advanced bronchial carcinoma with esophageal invasion.

Successive bilateral bronchial stenting (Dumon type) and minimally invasive pull-through esophageal intubation for accompanying malignant bronchial and esophageal involvement was undertaken. External radiation and afterloading brachytherapy for localized endobronchial overgrowth was used. A 13-month survival was achieved using mainly out-patient facilities. During such esophageal intubation, bronchoscopic control is mandatory. Extended complex palliation was obtained using this combined treatment, even in the high-risk stage of advanced tracheobronchial carcinoma with associated esophageal stricture.

Aged↗
PubMed1999

Radicality and prognosis of surgical treatment of thoracal carcinoid tumors: a review of 152 operated cases.

BACKGROUND: Experience of thoracal (bronchial and thymic) carcinoid tumors is discussed to add some remarkable diagnostic and therapeutic details for their treatment, based on a retrospective clinico-pathological analysis of 152 consecutive patients operated on at the Thoracic Surgery unit in Budapest between 1974 and 1988. METHODS: Prior to surgery 70 patients were symptom free, obstructive symptoms dominated in 65 patients, and hemoptysis occurred in 23 cases. In 68 patients a peripheral coin lesion was visible in radiographs and in 81 cases the tumor could be seen by bronchoscopy. In 3 patients the neoplasm appeared as mediastinal thymic-carcinoid. Pathological confirmation was based on routine light-microscopic sections, Grimelius technique, and immunohistochemical stainings for NSE and chromogranin. Bronchoplastic procedures were performed in 28 patients and limited (wedge or segmental) resection in 21 cases. RESULTS: Atypical carcinoids were diagnosed in 18 cases, microscopic vascular invasion could be seen in 70 tumors (46%), and 12 patients had a single hilar lymph-node metastasis. Immunostaining for NSE was evident in all carcinoids and 82% of the tumors presented positive reaction for chromogranin staining. Hospital mortality was 1.3%. The 5-year-survival rate amounted to 93% and the 10-year-survival rate to 83% (126/ 152). The early postoperative deaths were among 49 patients operated on by parenchyma-sparing methods; the rest of these 49 are alive and free of symptoms. Local recurrence occurred after a lobectomy and following removal of a mediastinal carcinoid. The tumors of 23 of the 26 dead patients showed vascular invasion, but 19 neoplasms among them had neither atypia nor regional lymph-node involvement. In the group of patients having tumors with signs of microscopic vascular invasion the 10-year-survival rate was 67%, while in the others it amounted to 96%. CONCLUSIONS: Bronchial carcinoids require anatomic resection with lymph-node dissection. On the other hand, however, parenchyma-sparing methods have to be encouraged because of excellent late results. In our experience, immunohistochemistry for chromogranin can give some help in separation on the neuroendocrine tumor scale, and the presence of microscopic vascular invasivity is the main prognostic factor.

Adolescent↗
PubMed1998

Surgical aspects of 175 mediastinal goiters.

OBJECTIVE: Clinical picture and surgical management of 175 mediastinal goiters are discussed in this retrospective study. METHOD: Between 1979 and 1996, 175 patients with intrathoracic goiters were operated on at the Thoracic Surgical Clinic in Budapest. The majority of the goiters were cervicomediastinal (n = 138, 79%), past the level of aortic arch, and the others were complete aberrant lesions (n = 37, 21 %). Of the patients, 40% (n = 70) were symptom-free, in the others the clinical picture was dominated by compressive symptoms, among them, in five instances, the initial false, long-lasting diagnosis was bronchial asthma and, in four cases, vena cava superior syndrome caused by advanced inoperable malignancy. Twenty-two percent of patients (n = 39) were operated on previously for cervical struma. Eleven percent (n = 19) of the patients had hyperthyroid symptoms. In 124 cases the goiters were located in the anterior mediastinum. The majority (n = 96) of cervicomediastinal goiters (n = 138) could be removed through a cervical access, in the others an additional sternotomy (n = 31), or anterior thoracotomy (n = 11) were necessary. For resection of complete intrathoracic goiters (n = 37) standard thoracotomy (n = 30) or median sternotomy (n = 7) were used guided by retrotracheal or substernal position. RESULTS: Hospital mortality was 1.1%. Minor complications occurred in 46 cases (26%) and laryngeal nerve palsy in 14 patients (8%). Tracheomalatia developed in 18 patients (10%) which were mainly solved by tracheal intubation for 4-6 days. Ninety-four percent (n = 165) of the lesions proved to be diffuse colloid or adenomatous goiters by histology and 10 were (mostly follicular type) carcinomas. CONCLUSIONS: Unrecognized mediastinal goiters can produce asthma like symptoms, which may lead to late or misdiagnosis and deficient treatment. Once the diagnosis and exact extent of mediastinal goiter is established, multimodal surgical approaches are indicated for its safe removal - before occurrence of compressive symptoms.

Adenocarcinoma, Follicular↗
PubMed1997

Multimodality treatment of esophageal disruptions.

The treatment of esophageal disruptions has changed since 1981. The value of a more selective assessment in six spontaneous ruptures and 30 mostly intrathoracic (83.4%) esophageal perforations is evaluated in this study. Based on the previous state of the esophagus, the time factor, and type and site of the disruption, reinforced primary repair (by diaphragmatic, muscular, pleural flap, or fundoplication), transhiatal closure, resection, intubation, suture combined with myotomy and fundoplication, esophageal diversion, and transhiatal mediastinal drainage were employed. The overall 30-day hospital mortality was 19.4%. Although these operations were mostly used in late (24 h to 7 months) perforations and ruptures, none of the patients with reinforced repair by autogenous diaphragmatic, muscular, or pleural flaps or fundoplication had fatal outcome for breakdown of the closure. Only patients with renal, cardiac, or multiorgan failure as a consequence of sepsis due to time elapsed before hospital admission died. The key to improve the prognosis of this life-threatening emergency is the more appropriate selection of the primary employed procedure.

Combined Modality Therapy↗
PubMed1997

Transhiatal closure of right-sided esophageal rupture after a left pneumonectomy.

Right-sided spontaneous esophageal rupture developed 2 days after left pneumonectomy and vomiting. To avoid contamination of the pneumonectomized left thoracic cavity as well as a contralateral thoracotomy, we used a transhiatal approach for primary repair of the rupture, combined with right-sided pleural and mediastinal drainage, gastrostomy, and feeding jejunostomy. The 7-day barium meal control showed healing of the rupture.

Aged↗
PubMed1997

Management of malignant tracheoesophageal fistulas with a cuffed funnel tube.

BACKGROUND: A detachable cuffed flange tube for the assessment of malignant tracheoesophageal fistulas by a minimal invasive surgical insertion technique is presented. The funnel cuff of this tube seals the space between the esophageal wall and the flange of conventional tubes above the fistula at the level of the suprastrictural dilatation. METHODS: Twenty-eight patients having a malignant esophagorespiratory fistula with associated primary or secondary esophageal stricture, except 1, underwent esophageal intubation with this prosthesis between 1983 and 1996. RESULTS: All insertion attempts, without previous esophageal dilation, were successful. The overall mortality was 7.4%. The cuffed funnel has provided hermetic water-tight exclusion of the fistula in all instances. Intraabdominal septic complications, reflux, or tube displacement have never occurred after use of this intubation technique. CONCLUSIONS: For occlusion of malignant respiratory tract fistulas this cuffed flange tube proved to be superior to conventional esophageal prostheses.

Equipment Design↗
PubMed1997

Particular aspects and limits of palliation of secondary malignant esophageal strictures.

The value of palliative intubation in the secondary malignant stricture of the thoracic esophagus is discussed. One hundred and eleven patients with secondary involvement of the esophagus due to primary inoperable (in 64) or recurrent bronchial tumor (after lobectomy or pneumonectomy in 34) and mediastinal tumor (in 9) or metastases after mastectomy of breast cancer (in 4) underwent a limited invasive surgical intubation with a personally designed, composite tube in the past 15 years. The distal part of the tube is detachable, which allows insertion of the tube only into the esophagus. The overall hospital mortality was 9.9%. Esophageal perforation and intraabdominal septic complication were never recorded. Nonfatal complication rate was low (5.4%). All survivors have resumed on oral soft diet. By this technique, all attempts of tube insertion were successful, although in 33% of the cases various esophageal axis deviations or tortuosity were present. Reintubation for tube dislodgement was necessary in 7.2% of the patients. Stenotic tracheobronchial invasion, vena cava superior syndrome, bronchial stump fistula as well as cardiac arrhythmias are the main contraindications of the palliative intubation in such cases. In the remaining group of patients with secondary invasion of the esophagus by intrathoracic malignancies, intubation may be considered a unique type of management with acceptable risk.

Arrhythmias, Cardiac↗
PubMed1996

Transdiaphragmatic cyst-jejunostomy with Roux-en-Y loop for an exclusively mediastinal pancreatic pseudocyst.

In a patient presenting with a roentgenographic retrocardiac density, left pleural effusion and distal oesophageal displacement, echocardiography confirmed presence of a pseudocyst in the posterior mediastinum. Pancreatic origin was suspected. Left thoracolaparotomy revealed the large (900 ml), exclusively mediastinal pseudocyst, surrounding the aorta and adherent to the diaphragm, with high amylase content. Decompression was achieved with a retrocolic and gastric Roux-en-Y loop by transdiaphragmatic cystojejunostomy.

Adult↗
PubMed1995

[Early diagnostic pitfalls in esophageal perforation and spontaneous rupture of the esophagus].

In this retrospective study (1981-1993) of 31 cases of esophageal perforations and ruptures circumstances the delay or misdiagnosis with undoubtable influence on the survival have been discussed. The over-all mortality was 16.1% but in cases of early (24 h) perforations or ruptures (12) no patients were lost. The unfavourable consequence of the superficial case history, underestimated pain, incomplete roentgenographic study, diagnostic confusion inadequate surgical exploration and misinterpreted postoperative complications of the formal esophageal surgery are analyzed. The authors emphasized the methods to decrease the number of the false-negative contrast esophagograms as well as the value of the intraoperative endoluminal diluted methylin-blue injection to detect esophageal leak. The early diagnosis is the first prerequisite for a favourable outcome in this life-threatening emergency.

Adult↗