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Biomedical subjects

J Hasse

Publications and source records attributed to J Hasse.

At least 73 records · Page 4Linked to original sources
PubMed1991

Surgery for primary, invasive and metastatic malignancy of the chest wall.

Forty-four patients with primary (n = 6), invasive (n = 19) and metastatic (n = 21) chest tumours underwent complete resection between 1986 and 1989 in a total of 46 consecutive procedures. Nineteen patients were female and 25 male; 2 patients, 1 male, 1 female, had second operations. The underlying disease was bronchial carcinoma in 17 (14 male), mesenchymal tumours in 17, metastatic breast cancer in 7 and miscellaneous in 5. The chest wall resection included up to 6 ribs. The manubrium was resected in 2 patients, the corpus sterni in 5. Pulmonary resection was performed in 36 cases in an en-bloc fashion. Other concomitant resections included the pericardium, diaphragm or transverse process of the vertebrae. Amputation of the right arm was necessary in two cases. Reconstruction of the thoracic cage was accomplished with PTFE soft tissue patches in 7, methyl methacrylate implants in 2, Marlex mesh in 1 and Vicryl net in 6 cases. In the majority of cases, particularly in dorso-apical and posterior defects, no substitutes were used. A variety of plastic procedures including the use of omentum, musculo- and fasciocutaneous flaps was employed for the reconstruction of the integument. There was no operative mortality. Fourteen patients died after surviving 2-25 months. Serious infection occurred in 1 patient and minor delay of healing in 2. Good palliation can be achieved at low risk. The effect on long-term survival remains uncertain, depending on the basic pathology.

Adolescent↗
PubMed1991

Reconstruction of chest wall defects.

A series of 61 consecutive procedures of chest wall resection and reconstruction in 58 patients during the period between August, 1986 and December, 1990 is reported. The ages ranged between 6-77 years. The chest wall resection was indicated for malignant affections in 54 cases. Among these, there were 24 patients with bronchial carcinoma invading the chest wall, 17 patients with primary or metastatic sarcoma, 11 patients with recurrent breast cancer and 3 with cancer metastases of varying origin. Pulmonary resection included pneumonectomy in 8 cases, lobectomy in 19, segmental and wedge resections in 26. In the majority of resections, the reconstruction was accomplished without implants. In cases with full thickness removal of the chest wall, the plane of the rib cage and/or the sternum was reconstructed using Vicryl mesh (n = 7), PTFE soft tissue patch (n = 11), marlex-mesh (n = 1), or methyl-methacrylate (n = 3). There was one case of hospital mortality, 6 weeks postoperatively, due to neurological failure from an independent preoperatively undiagnosed brain tumor. There were 4 reoperations: one early and one late (4 months) infection, one case of limited superficial necrosis of a flap and one with chronic lymphous drainage from a large myocutaneous flap. In no instance was primary postoperative ventilation therapy necessary. Mechanical ventilation was instituted only on day 8 in the patient who accounts for the mortality in this series. In the presence of primary infection, the greater omentum was used for the restoration of the integument.

Adenocarcinoma↗
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↗
PubMed1990

Surgery in bronchial carcinoma with metastasis.

Two groups of lung cancer patients with solitary M1 disease are presented in whom lung resection was performed at the time of or after operative treatment of the metastasis. Nine patients had solitary brain metastasis prior to the resection of the primary tumor. Six died, with an average survival of 10 months post-thoracotomy, 3 survive after 15 to 31 months. The results are less favorable than suggested by the literature where often cases are included which have brain metastasis after lung cancer surgery. Another eight M1 situations in this series are predominantly lung cancers with pleural disease. Improvement of quality of life and substantial survival times have been observed, though most patients are still at risk after a survival of from 15 to 35 months. As to the histological features, adenocarcinoma was the most frequent type followed by the adenosquamous variant. Lung surgery should be considered in selected cases in spite of known or formerly treated solitary distant metastasis.

Adult↗
PubMed1990

Patch-closure of tracheal defects with pericardium/PTFE. A new technique in extended pneumonectomy with carinal resection.

Patch closure of a tracheal defect resulting from extended pneumonectomy including the main carina and a limited area of the lower trachea or the opposite bronchus is described in five cases of bronchogenic carcinoma and one case of metastatic melanoma. It was accomplished by the use of a PTFE soft-tissue patch and integrated pericardial flap. Airway continuity was satisfactorily restored in all but one case with a longest survival of 30 months. One patient developed an empyema and died from respiratory failure after 6 weeks. The method is technically easy and can serve as an alternative to resection of the whole bifurcation in selected cases. Intraoperative ventilation using double lumen tubes needs not be altered.

Adult↗
PubMed1990

Surgical treatment of bilateral chylothorax due to benign lymphangioma of the thoracic duct.

We present a female patient in whom after an 8-year history of recurrent bilateral pleural effusions, a benign lymphangioma of the thoracic duct was diagnosed and successfully treated by ligation of the duct, resection of the tumour and simultaneous decortication of the right pleural space and lung. This observation supports surgical intervention in this condition even in patients of advanced age.

Aged↗
PubMed1990

Decortication in chronic pleural empyema. Investigation of lung function based on perfusion scintigraphy.

The study presents measurements in spirometry and scintigraphic lung perfusion, before and after decortication, in 9 patients treated for chronic pleural empyema with special emphasis on measuring changes by perfusion scintigraphy. Preoperatively, the average vital capacity (VC) 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↗
PubMed1990

Heart valve replacement with the Björk-Shiley and St Jude Medical prostheses: a randomized comparison in 178 patients.

In 178 patients, a randomized prospective comparison between the 60 degrees spherical disc Björk-Shiley (BS) and the St Jude Medical (SJM) heart valve prostheses was performed. Four-week perioperative mortality was zero in the BS (n = 84) and 4.3% in the SJM group (n = 94). During a mean (+/- SD) follow-up of 52 +/- 20 months or 778 patient-years, late cardiac mortality per year was 2.4% in the BS and 2.2% in the SJM group. The yearly thromboembolic rates were 1.4% in the BS and 2.0% in the SJM group. There was no mechanical valve failure or haemolytic anaemia. Paravalvular leaks and major bleeding complications occurred at low rates in both groups (1.1% and 2.2% per year in BS; 0.7% and 1.7% per year in SJM). Functional results were similarly good with 96% of patients with BS valves and 95% of patients with SJM prostheses being in NYHA classes I and II, respectively. We conclude that heart valve replacement with mechanical prostheses can be performed with equally good results using either the Björk-Shiley spherical disc valve or the St Jude Medical bileaflet prosthesis.

Aged↗
PubMed1990

[Palliative surgical indications in bronchial cancer].

Surgical palliation in bronchial carcinoma may be indicated for severe hemorrhage, putrid expectoration in large necrotising tumors, recurrent pleural effusion refractory to conservative treatment and loss of function of an entire lung due to bronchial and vascular obstruction. Alleviation of imminent asphyxia, dyspnea or malaise is the main purpose, whereas prolongation of survival remains uncertain. Palliative surgery is ranging from tumor pleurectomy to total pleuropneumonectomy. Depending on an individual situation this might be done as a primary indication or, if aforementioned complications must be anticipated, during elective surgery in advanced lung cancer instead of merely explorative thoracotomy. Bronchial obstruction with maintained lung perfusion alternatively is an excellent indication for endoscopic laser surgery, mostly combined with subsequent 192Ir afterloading therapy. Twenty-three cases of primary and secondary surgical palliation within a two-year period and 55 cases of laser/afterloading therapy in a three-year period are analyzed. Survival time is limited in the latter. Due to better general and functional state in the small surgical series in several patients not only relief from badly tolerated symptoms was achieved but also surprisingly long periods of survival with good quality of life in several cases. With proper selection operative mortality and morbidity of palliative surgery as well of laser therapy is of minor concern.

Adenocarcinoma↗
PubMed1990

[Developments in surgery of pulmonary metastases].

Two groups of patients between 1977-1986 and 1987-1989 underwent surgery for pulmonary metastases. The most frequent primary sites were the kidney and the colon-rectum. While metastases from testicular cancer have become rare indications, metastases from breast cancer are increasing. Our results show that more metastatic lesions are usually found at operation than indicated by CT scan. The discrepancy amounts to 18% in presumably solitary metastases and increases to 50% if three or more lesions were identified preoperatively. Therefore, bilateral exploration is advocated. Lesions of the posterior lower lobes are more satisfactorily approached by a bilateral transverse incision and sternotomy. The mortality was 1% in the former and 0% in the more recent group of patients.

Carcinoma↗
PubMed1989

Sudden cardiac death after aortic valve surgery: incidence and concomitant factors.

A retrospective analysis of 599 consecutive patients after aortic valve surgery aged 7-82 years (mean 56) was performed. During a follow-up of 1-14 years (mean 4.7 years) a 4-week perioperative mortality of 6.9% and a late annual mortality of 3.6% were observed. Sudden cardiac death was the most frequent single cause of death, accounting for 24% of all deaths. Patients dying suddenly were younger than patients dying from other causes (51 +/- 17 vs. 59 +/- 14 years, p less than 0.05) and showed more left ventricular hypertrophy by electrocardiographic criteria when compared with matched survivors (mean Estes score 5.2 +/- 2.4 vs. 2.8 +/- 1.9; p less than 0.01) and with patients dying nonsuddenly (mean Estes score 5.2 +/- 2.4 vs. 1.8 +/- 1.8; p less than 0.01). Ventricular premature beats in the resting electrocardiogram were more prevalent in patients dying suddenly than in matched survivors (55 vs. 20%; p less than 0.025) as well as in patients dying from other causes (55 vs. 25%; p less than 0.05). In addition, there were more intracardiac conduction disturbances and more ungrafted coronary vessels with insignificant stenoses at the time of surgery in sudden death patients. Our findings suggest that after aortic valve replacement patients with left ventricular hypertrophy, bundle-branch block, and ventricular premature beats in the resting electrocardiogram are at increased risk for sudden cardiac death. A possible etiological role of concomitant coronary artery disease must be considered.

Adolescent↗
PubMed1989

[Stent implantation as a palliative measure in an inoperable bronchial tumor. Initial experiences with an endoscopically implanted stent].

Imminent asphyxia due to tracheal or bronchial compression by inoperable tumors in the mediastinum and the central bronchi is serious, particularly if alternative treatments, i.e., radiation or chemotherapy, have been exhausted. For that reason, stents of different diameters and lengths were developed that could be dilated. With the patient under general anesthesia these stents can be introduced into the stenotic bronchus or trachea through a rigid bronchoscope. The appropriate stent is mounted on a 3-mm balloon catheter, which is inflated after the stent is in the correct position. Positioning is done under direct bronchoscopic and fluoroscopic control. After deflation of the balloon, the stent maintains its cross-sectional shape and keeps the airway open. The first clinical application was in a 53-year-old patient with end-stage small-cell carcinoma. The patient had had a relapse after combined chemo- and radiotherapy and had severe stridor. Stent insertion led to a significant relief of symptoms. The second patient, a 53-year-old woman who suffered from collapse of the bronchus caused by a radionecrosis, was treated by the same method. Nine months later, ventilation is excellent in the left lung, and the patient can tolerate the stent without any clinical symptoms. A 69-year-old woman suffered from a tracheal carcinoma with severe tracheal stenosis. It was possible to maintain the stability of the collapsed tracheal wall by insertion of a tracheal stent. This new technique can provide good palliative treatment and is sometimes even the main therapy in such cases.

Aged↗
PubMed1988

Phase-II study with the combination of cisplatin and doxorubicin in advanced malignant mesothelioma of the pleura.

The effectiveness of combination chemotherapy with doxorubicin and cisplatin was studied in patients with advanced malignant pleuramesothelioma. 19 patients were treated intravenously with cisplatin 60 mg/m2/day on days 1 and 2, and with adriamycin 40 mg/m2 on day 3 every 4 weeks. 8/19 patients (46%) responded to chemotherapy; 2 achieved complete remissions (CR), and 6 went into partial remissions (PR). Median duration of response was 222 days. Median survival time of all patients was 370 days compared to a median survival of 273 days in a historical control group consisting of 30 patients treated by surgery only. Substantial toxicity was observed, mainly gastrointestinal. We conclude that the combination of cisplatin and adriamycin is effective in malignant pleuramesothelioma. However, the duration of treatment is limited by gastrointestinal toxicity.

Antineoplastic Combined Chemotherapy Protocols↗