PubMed Health⌕ Search

Biomedical subjects

L Swoboda

Publications and source records attributed to L Swoboda.

At least 19 recordsLinked to original sources
PubMed1998

[Perforation into the heart--a rare complication of stomach ulcer in hiatal hernia].

Perforation into the heart is a rare ulcer complication in a hiatal hernia. Because of the massive bleeding, medical help is often in vain. The case of a 73-year-old patient reported by our department confirms this. Endoscopic treatment was not possible because of the extraordinary amount of blood in the stomach, and the high intraoperative blood loss was lethal. If gastric ulcers occur in upper regions of the stomach, the possibility of the presence of an paraesophageal hernia and elective surgical treatment must be considered.

Aged↗
PubMed1998

Results after surgery in stage-I bronchogenic carcinoma.

BACKGROUND: The aim of this retrospective study was to evaluate prognostic factors for recurrence-free survival in stage-I non-small-cell bronchogenic carcinoma. METHODS: During 9 years, 338 consecutive patients were operated on for stage-I bronchogenic carcinoma. Patients with small-cell carcinoma (n = 14), prior malignancies in locations other than pulmonary (n = 41), and patients with incomplete data on prognostic factors (n = 11) were excluded. Of the remaining 272 patients 226 were men. Mean age was 63 years (40 to 81 years). The resections performed comprised 215 lobectomies and bilobectomies, 36 segmentectomies and wedge resections, and 21 pneumonectomies. According to the number of sites of dissected lymph nodes 3 subgroups were formed: group A with 0 to 4 (n = 71), B with 5 to 6 (n = 118), and C with 7 to 10 sites (n = 83). Median follow-up was 46 months. RESULTS: Three patients (1.1 %) died within 30 days of operation. In 3 patients the resection was revealed to be not radical (R1). At the end of follow-up, 191 patients were alive, 174 of these without recurrence. Eighty-one patients had died, 53 associated with tumor recurrence. Four patients had died of non-pulmonary malignancies. Twenty-two patients died of causes not related to tumor disease. In 2 patients the cause of death could not be determined retrospectively. Overall 5-year survival was 65% (95% confidence interval [CI] 58-72%), recurrence-free survival 59% (CI 51-66%). Significant prognostic factors for recurrence-free survival were T stage (relative risk [RR] 1.7 for T2 vs. T1, CI 1.0-3.0), age (RR 1.9 for >70 years vs. < or =70 years, CI 1.1-3.1), adeno cell type (RR 2.3 vs. squamous cell, CI 1.4-4.0), as well as lymphangiosis carcinomatosa (RR 2.3, CI 1.2-4.4). Extent of operative resection, extent of lymphadenectomy, and sex did not influence survival. CONCLUSION: 5-year survival of our patients was in the range reported in literature. Most patients died of distant metastases. Our retrospective study probably underestimated the occurrence of second primary cancers of the lung. Limited resection in poor-risk patients showed equivalent results to lobectomy. The extent of lymph-node resections had no influence on survival of stage-I patients, however, it must be remembered that positive results in lymph nodes shift patients to higher stages.

Carcinoma, Bronchogenic↗
PubMed1997

Experimental gluing of lung parenchyma in rats.

Gelatin-resorcinol-dialdehyde adhesive has been developed from a gelatin-resorcinol-formaldehyde adhesive by replacing the formaldehyde with two less histotoxic dialdehydes, ethandial and pentandial. The aim of the present study was to evaluate the usefulness of this modified composition in gluing defects in lung parenchyma. In 40 male Wistar rats a standardized lung incision 1.0 cm in length and 0.8 cm in depth were closed by application of gelatin-resorcinol-dialdehyde adhesive. For macroscopic and microscopic examination 4 animals were sacrificed on each of postoperative days 2, 7, and 14 and 14 animals on each of postoperative days 28 and 120. Macroscopic examination revealed a tight closure of the parenchymal defects in all postoperative stages. Initially by an adhesive layer and later on by granulation tissue and scar tissue respectively. On microscopic examination an inflammatory tissue response with polymorphonuclear neutrophils and macrophages predominating was found 2 days postoperatively. After 7 days multinucleated giant cells appeared. On postoperative day 14 the tissue response presented a distinct granulomatous character with multinucleated giant cells persisting. After 28 days remnants of adhesive surrounded by granulation tissue were detectable. On postoperative day 120 the adhesive had been completely resorbed and the parenchymal defect was replaced by fibrous scar tissue. The gelatin-resorcinol-adhesive proved effective in tight closure of lung parenchyma in rats. The adhesive is resorbed completely and does not interfere with parenchymal healing.

Absorption↗
PubMed1996

[Surgical treatment of bronchial carcinoma in advanced age].

As live expectancy increases, the number of elderly patients 70 and more years of age are also increasingly represented in a thoracic surgical series. The preponderance of malignant disease in this group, particularly lung cancer, is common. Progress in anesthesia, intensive care and operative techniques in recent years has reduced the risk of morbidity and operative mortality in this age group. Operative and 30-day hospital mortality was 4.8% in our series.

Aged↗
PubMed1994

Evidence for preservation of epithelial function in cryopreserved porcine and human bronchi.

Porcine and human bronchi have been investigated in vitro without or after storage at -196 degrees C in Krebs-Henseleit solution containing 2.0 M dimethyl sulphoxide and 0.1 M sucrose as cryoprotectants. In bronchi from both species maximal post-thaw contractile responses to acetylcholine (ACh) were reduced by about 25-30% compared to unfrozen bronchi. To assess the viability of bronchi and endothelium-denuded rat aortic strips, was employed. The release of an epithelium-derived inhibitory factor (EpDIF) was induced by ACh and assessed in terms of concentration-dependent relaxation of the endothelium-denuded rat aortae. Following removal of bronchial epithelium, ACh failed to elicit any relaxation of rat aorta. With cryopreserved bronchi from both pig and human about 5 and 30 times higher concentrations of ACh, respectively, were required to elicit the same relaxant response as with unfrozen bronchi. The results suggest that after the freezing-thawing process both smooth muscle and epithelial function is largely preserved and provide support for the use of cryopreservation for storage of airway preparations for pharmacological studies.

Acetylcholine↗
PubMed1994

Pulmonary arteriovenous malformations. Case reports and literature review.

Pulmonary arteriovenous malformations (PAVM) represent an uncommon disease with only 500 reported cases. To emphasize the resectional surgical standard, 2 patients with PAVM and pulmonary right-to-left shunt are presented and the optional treatments discussed. One patient had suffered from a cerebrovascular accident. The other patient's diagnosis resulted from a coincidental finding in connection with an unrelated illness. Because of the risk of acutely developing complications, especially disabling or fatal cerebral ischemia, therapy is generally recommended even in asymptomatic patients. The 2 patients presented here were treated by resection. Surgical treatment with a very low risk and parenchyma-sparing technique remains the golden standard for large isolated malformations. In addition to the established and reliable operative therapy, since 1978 catheter embolization is becoming the method of choice with an increasing range of indications in those centers experienced with this technique.

Adult↗
PubMed1994

A modified ex-vivo rabbit lung reperfusion model for the study of lung preservation techniques.

Extracorporeal reperfusion models have proved to be particularly useful for the experimental assessment of donor lung preservation techniques. One disadvantage of the models employed to date is what with the low reperfusion rates used, any minimal lung damage is compensated for and is thus not detected or at least not detected promptly. By permitting reperfusion at physiological flow rates, use of a membrane deoxygenator in a closed circuit permits early detection of damage due to ischaemia or reperfusion. A modified ex-vivo reperfusion model is presented which permits assessment of lung function under almost physiological conditions after varying periods of ischaemia and varying conditions of preservation.

Animals↗
PubMed1993

[Thoracic surgery in advanced age. Indications and results with special reference to bronchial cancer].

BACKGROUND: As the life expectancy in the general population increases, a constant rise in the number of patients of advanced age undergoing thoracic surgery is also observed. MAJOR TOPICS DISCUSSED: Among the indications for operations on the chest, malignant diseases head the list. Thanks to advances in anesthesia, intensive care and surgical techniques, the peri-operative mortality rate in this age group has been appreciably reduced in recent years. In our own patient material, the relevant figure was 4.37%, and is thus in the lower range of internationally comparable mortality associated with major oncological operations on the chest. CONCLUSION: Patients in their seventies or eighties should not be denied thoracic surgery for age reasons; the decisive factors are the general level of activity of the patient and his/her motivation.

Aged↗
PubMed1993

The influence of verapamil on lung preservation. A study on rabbit lungs with a reperfusion model allowing physiological loading.

Calcium-channel blockers have recently been shown to improve myocardial and renal preservation. It was presumed that this should apply also for donor lungs. Extracorporeal reperfusion models have proved to be particularly useful for the experimental assessment of donor-lung preservation techniques. One disadvantage of the models employed to date is that with the low reperfusion rates used, any minimal lung damage is compensated for and is thus not detected or at least not detected promptly. The aim of this study was the investigation of the effect of verapamil in a modified reperfusion model with physiological volume/time flow ratio during reperfusion. The application of verapamil into the flush and into the reperfusion blood of an ex-vivo lung transplantation model renders, particularly after 12 hr of preservation, a statistically significant improvement of the organ function.

Animals↗
PubMed1993

Carcinosarcomas of the lung. Three case reports and literature review.

Therapy and course of pulmonary manifestations of carcinosarcomas in three patients are described. For this rare mixed tumor there is a prevalence among men between the ages of forty and seventy. Operative therapy should be employed whenever possible, because of the poor results achieved thus far using radiotherapy or chemotherapy. Carcinosarcomas were thought to have a worse prognosis than other non-small-cell bronchial carcinomas but an increasing number of reports indicate a similar clinical course and prognosis. Pneumonectomy was required for two of our patients and lobectomy was performed in the third. The period of observation extended over two years. One patient, tumor stage T4N0M0 died of his disease after seven months. The two other patients, tumor stages T3N0M0 and T2N1M0, were operated on thirty-three and thirty-five months ago respectively and are clinically disease-free and in good health.

Aged↗
PubMed1993

Cryopreservation of human bronchi.

Human bronchi have been investigated in vitro without or after storage at -196 degrees C in different media containing 1.8 M dimethyl sulfoxide and 0.1 M sucrose as cryoprotectants, dissolved in either fetal calf serum (FCS), Krebs-Henseleit solution (KH), or 50% FCS in KH as vehicles. As assessed by the post-thaw responses to both carbachol and histamine, optimal preservation of contractile responsiveness was obtained with bronchi that had been frozen in a medium containing KH solution as the vehicle. With each group of cryopreserved bronchi, maximal responses to relaxant agonists such as isoprenaline, papaverine, and the potassium channel activator bimakalim were attenuated by up to 50%, and the passive resting tension after maximal pharmacological relaxation was considerably higher than in the unfrozen tissues. The evidence suggests that, despite some reduction in elasticity, cryopreservation of human bronchi at -196 degrees C preserves both contractile and relaxant mechanisms and offers clear potential for storing human airway smooth muscle for subsequent pharmacological experiments.

Animals↗
PubMed1993

[Recurrent intervention in surgery of pulmonary metastases].

Pulmonary resection for recurrent metastatic disease in 39 patients undergoing 52 thoracotomies resulted in a cumulative survival rate of 75% at 3 years an 52% at 5 years, with no operative mortality. A significant factor influencing survival was duration of disease-free interval after treatment of primary tumor and the time interval between the first pulmonary metastasectomy and the appearance of recurrent pulmonary metastases. The route of metastatic spreading and the number of metastases were of no prediction for postthoracotomy survival.

Adolescent↗
PubMed1993

[Tracheal and bronchial rupture after blunt thoracic trauma].

Airway disruptions after blunt chest trauma are rather infrequent with an incidence of about 1%. Even in large centers with many such casualties they are episodical. The clinical picture is not an uniform one, and typical clinical signs occur often without an airway lesion. Therefore, the correct diagnosis may be delayed. Two case reports, one with a tracheal rupture, the other with complete disruption of the main right bronchus are presented. Both patients showed significant soft tissue emphysema, increasing dyspnea and hypoxia respectively within a few hours after their accident. The diagnosis was established bronchoscopically after time intervals of 8 and 32 hours respectively, followed by immediate surgical correction. Both patients experienced a smooth recovery with good longterm results. In blunt chest trauma presenting with subcutaneous emphysema, pneumomediastinum, pneumothorax, hemoptysis and respiratory distress, tracheobronchial disruption should be considered. In this case, expert bronchoscopy, preferably by a surgeon with large thoracic experience, is mandatory.

Adolescent↗
PubMed1992

Perioperative antibiotic prophylaxis in general thoracic surgery.

A prospective study of the efficacy of ampicillin in combination with sulbactam, a beta-lactamase inhibitor, (A/S) in perioperative prophylaxis was performed. The study consisted of two independent parts performed at the same time. Part I included 60 patients with lobectomies and segmentectomies. Group A (A/S 1 x 3 g "single shot") was compared with group B (A/S 3 x 3 g). Superficial wound infections occurred in 3 patients of group A and in 2 patients of group B. There was no empyema. Bronchitis and pneumonia were found in 10 patients of group A and in 7 patients of group B. Part II examined 25 pneumonectomies receiving A/S 3 x 3 g for 3 days. Concentrations of ampicillin and sulbactam in serum and lung tissue were determined and showed adequate levels to cope with usual bacteria in lung surgery. There was one superficial wound infection, 2 cases of bronchitis, and 2 cases of pneumonia.

Ampicillin↗
PubMed1992

[New developments in surgery of pulmonary metastases].

Two groups of patients, 107 between 1977-1986 and 122 between 1987-1991, who underwent surgery for pulmonary metastases, were compared with each other. The most frequent primary sites were the kidney and the testes in the first and the kidney and the colon-rectum in the second group. We recorded a 1-year survival rate of 79% and a 5-year survival rate of 37% in the first group. In the second group there was a 3-year survival rate of 53%. Our analyses are showing that more metastatic lesions are usually found at operation than indicated by CT scan preoperatively. The discrepancy amounts to 19% in presumably solitary metastases and increases to 50% and more if two or more lesions were identified preoperatively. Therefore, bilateral exploration is advocated as a standard procedure in pulmonary metastatic surgery.

Adolescent↗
PubMed1991

[Improving function by decortication. Functional studies with particular evaluation of lung perfusion scintigraphy].

The study presents functional and scintigraphic lung perfusion measurements before and after decortication of 9 patients treated for chronic pleural empyema with special emphasis to changes in perfusion scintigraphy. Preoperatively, the average vital capacity was 60% and the average FEV1 was 65% of the predicted. Perfusion of the affected side showed an average reduction to 22%. After decortication all functional data showed an improvement (average VC 78.5%, average FEV1 79.5%) the percentage of lung perfusion having increased to a mean of 37.8%.

Adolescent↗