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Biomedical subjects

H N Macha

Publications and source records attributed to H N Macha.

At least 37 records · Page 2Linked to original sources
PubMed1991

[Endobronchial brachytherapy: endoluminal small-volume irradiation of bronchial tumors using the high-dose-rate afterloading method].

Endobronchial irradiation has been in use for over 70 years. This method of treatment has become much less of a burden to the patient thanks to developments in isotope technology, bronchoscopy and radiation therapy. It is effective in providing good palliation and in central bronchial tumours with involvement of the large airways, endobronchial irradiation has proved to be a valuable addition to our armamentarium. In the context of curative irradiation it may be combined with external beam irradiation. In tumours confined to the bronchial wall, endobronchial irradiation alone has been successfully used to achieve a cure. This method should however only be used in large thoracic centres as there are relatively few indications for its use.

Brachytherapy↗
PubMed1990

[Mediastinal staging of non-small cell bronchial carcinoma. The place of computed tomography and mediastinoscopy].

Sixty patients with a potentially resectable non-oat-cell lung carcinoma were examined by computed tomography and cervical mediastinoscopy. The sensitivity of computed tomography as opposed to mediastinoscopy was 74% versus 58% and the specificity in 85% versus 100%. Considering the limitations of both methods and the varying prevalence of mediastinal lymph-node metastases associated with peripheral and central lesions, three different situations can be distinguished: 1. with peripheral lesions and a normal mediastinal CT, preoperative mediastinoscopy is unnecessary. 2. With an abnormal mediastinal CT, mediastinoscopy is always indicated irrespective of the location of the tumor. 3. With large central lesions, mediastinoscopy is necessary even when the CT is normal. Using these rules, 37 of 60 mediastinoscopies in our patient group could have been avoided without influencing the resection rate (98%).

Adult↗
PubMed1990

[Thrombosis of the left jugular-subclavian vein junction as a rare late complication of oleothorax].

Thirty years after bilateral pneumolysis followed by plombage with paraffin for bilateral upper lobe tuberculosis, a 58-year-old female patient suffered a thrombosis of the left jugular- subclavian vein junction. Compression of the vessel by the plombage in addition to chronic fibrous scar tissue reaction must be assumed as the main cause of thrombosis, since infection of the plombage space was excluded.

Collapse Therapy↗
PubMed1989

The diagnosis, therapy and prognosis of diffuse malignant mesothelioma.

Between 1969 and 1985, 245 patients with diffuse malignant mesothelioma were treated (157 male, 88 female). The average age was 55.8 years and the sex ratio was 1.8:1 in favour of males. The right side was more frequently affected than the left (56.7% vs. 43.3%). A pleural effusion and dyspnoea were the presenting signs and symptoms in 83.7% of the patients and unilateral chest pain in 64.2%. Noninvasive diagnostic procedures included a chest X-ray and computed tomography of the thorax. Pleural effusion and pleural thickening were detected most frequently. Malignant cells were identified by pleural fluid cytology in 45.3% and by needle biopsy of the pleura in 42.7% of the patients. Forty-five patients were treated conservatively and 200 patients underwent operation: diagnostic thoracotomy (78); partial pleurectomy (72); total pleurectomy (46); extended pleuropneumonectomy (2); partial removal of the diaphragm (1) and total pleurectomy and upper lobectomy (1). The perioperative mortality was 6%. The conservative and postoperative treatment depended on the patients' symptoms and included radiotherapy and chemotherapy alone or in combination. The mean survival time of the 222 non-survivors was 9.2 months. After 1 year, 36% of the patients were still alive, after 2 years, 10.8% and the 5-year survival was 4.1%. The median survival time in patients treated non-operatively was 6 months--a little over half that of the patients treated surgically (10.1 months).

Adult↗
PubMed1987

New technique for treating occlusive and stenosing tumours of the trachea and main bronchi: endobronchial irradiation by high dose iridium-192 combined with laser canalisation.

A new technique is described for treating patients with inoperable malignant tumours causing occlusion or stenosis of the trachea or main bronchi. High dose iridium-192 (20 Ci) was introduced by an afterloading device under computer control via a 4 mm delivery tube into the tumour mass. In 29 of the 56 patients the tumour mass was canalised by a neodymium-YAG laser immediately before the afterloading delivery tube was introduced. In 44 (79%) of the patients, there was impressive relief of dyspnoea, accompanied by tumour regression observed at endoscopy and also by highly significant improvement in ventilatory function values, lung perfusion scans, and levels of arterial oxygen tension. In the other 12 patients (21%) there was no detectable improvement. The findings suggest that this recently developed combination treatment is of value in patients with advanced tumours of the trachea and main bronchi in whom there is no possibility of further treatment by external irradiation or repeated laser coagulation.

Aged↗
PubMed1986

[New methods in the radiotherapy of bronchial carcinoma. Endobronchial small-field irradiation using the iridium-129 high-dose afterloading technic in combination with the neodymium-YAG laser].

106 patients with inoperable malignant tumours constricting the central bronchial tree underwent endobronchial small-field radiotherapy with iridium-192 at high dose between June 1983 and September 1985. Treatment was performed using the computer-guided after-loading technique and a flexible bronchoscope under local anaesthesia. In complete occlusion of a bronchus by the tumour, a neodymium YAG-laser was applied (57 patients) to allow insertion of the after-loading probe. Endoscopy showed tumour regression in 75% of the patients, accompanied by clinical improvement. Pulmonary function tests, arterial blood gas analyses and pulmonary perfusion scans yielded a highly significant improvement of data after treatment. The procedure also proved effective upon exhaustion of external radiation. Apart from its positive palliation, endobronchial small-field radiotherapy using high doses of iridium-192 also has a curative effect, thus opening up a new approach to the therapy of advanced bronchial carcinoma.

Aged↗
PubMed1985

[New possibilities in radiotherapy of endobronchial tumors using the afterloading method in combination with laser technics].

New possibilities for radiotherapy of bronchial carcinomas are provided by the combined application of the recently introduced afterloading method used hitherto in the treatment of stenosing processes of bronchial carcinomas and the neodyme-YAG laser which opens the stenosis in such a manner that the afterloading probe can be inserted. This new method allows to perform without complications or disadvantages further combined therapies such as percutaneous irradiation (telecobalt, linear accelerator or betatron). An irradiation scheme leading to a decisive tumor regression can be established due to the fast reventilation of the lung obtained by both methods. Surprisingly, three patients could be submitted despite the small-field radiotherapy to rather important lung operations such as lobectomy and pneumonectomy which were performed without complications or disadvantages. The patients were not operable without laser and afterloading therapy. This method was applied several times in the treatment of other diseases such as oesophageal cancer and stenosing cancer of the antrum. In these cases, a normal ingestion due to tumor regression was obtained rapidly.

Brachytherapy↗
PubMed1982

Comparative studies of atropine methonitrate and its combination with reproterol in chronic airway obstruction.

The therapeutic value of 80 micrograms atropine methonitrate delivered per metered aerosol and its combination with 450 micrograms reproterol was investigated in a controlled double-blind cross-over trial in 17 patients with chronic bronchitis and airway obstruction. All patients were atropine responders. According to the parameters of FEV1 and SGaw atropine methonitrate induced a statistically definite and clinically relevant bronchodilation for more than 3 h compared with placebo. The combination of 80 micrograms atropine methonitrate and 450 micrograms reproterol, however, proved to be clearly superior compared with the mono-compound atropine methonitrate.

Aerosols↗
PubMed1980

Beta-adrenoceptor blockers and terbutaline in patients with chronic obstructive lung disease. Effects and interaction after oral administration.

We studied the effects of a combined treatment with beta 2-stimulating and beta-blocking drugs in 35 patients suffering from chronic obstructive lung disease (COLD) and ischemic heart disease, and/or arterial hypertension. The drugs used were equipotent repeated oral doses of metoprolol (100 mg twice daily [bid]), propranolol (80 mg bid), and a matching placebo for beta-adrenoceptor blockade given in a double-blind and crossover fashion. The intake period of each beta-blocker was two days with consecutive two-day-washout period; 2.5 mg terbutaline and beta-stimulator placebo, respectively, were given throughout the whole trial three times daily (tid). Propranolol alone caused severe deterioration of lung function. After 18 patients had been studied, this drug had to be excluded from the trial. When compared with placebo, metoprolol provoked increasing obstruction, too, but to a significantly lesser degree than propranolol. These negative effects on FEV1 and FRC were completely equalized by terbutaline. Predictive factors for the tolerability of beta-blockers in patients with COLD could not be found. Therefore, careful observations in the initial phase of the treatment with beta-selective blockers are necessary.

Administration, Oral↗
PubMed1979

Efficacy of reproterol assessed by the acetylcholine provocation test.

The acute broncholytic efficacy and the protective anticonstrictive effectiveness of a new beta 2-receptor stimulator, Reproterol, was tested in 16 patients with the acetylcholine (ACH) provocation test. Plethysmographic airway resistance determinations (Raw) and flow volume curves (VEmax50%/FVC) were used as assessment parameters. All patients proved susceptible to ACH provocation, in as much they demonstrated a significant rise in the Raw from 2.46 to 11.53 cm H2O/1/sec and a significant decline of the VEmax50%/FVC from 884 to 565 (ml/sec/1) following ACH administration. With Reproterol inhalation (2 puffs at 500 mu each), almost complete elimination of ACH-induced bronchial constriction was achieved. The ACH provocation with the same patients the following day, however, was almost absent 60 min after oral ingestion of 20 mg of Reproterol tablets. Dose-efficacy studies in 7 volunteers from the same group revealed a subjectively better tolerance of the 10-mg tablets, but with a correspondingly lower antibronchia constrictive efficacy.

Acetylcholine↗