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Biomedical subjects

T L Winton

Publications and source records attributed to T L Winton.

29 records · Page 2Linked to original sources
PubMed1990

Airway complications after double lung transplantation. Toronto Lung Transplant Group.

We have had success with en bloc double lung transplantation in the management of selected patients with end-stage parenchymal pulmonary disease. Airway complications have been more prevalent in our own experience with double lung transplantation than in reports of combined heart-lung transplantation from other centers. Between November 1986 and March 1989, 16 patients underwent double lung transplantation. Allografts were preserved by topical hypothermic immersion in 12 patients and by pulmonary artery flush with cold crystalloid solution in the most recent four patients. Thirteen patients underwent tracheal anastomosis and the most recent three patients underwent bilateral bronchial anastomoses. Fatal ischemic necrosis of the donor trachea and both main bronchi developed in three patients. Preterminal airway ischemia developed in a patient who had systemic sepsis. Partial anastomotic dehiscence, which went on to form fibrous strictures necessitating endoscopic placement of silicone rubber airway stents, developed in two additional patients. Two other patients had late strictures and required subsequent placement of bifurcation stents. There was no relationship between development of airway complications and gas exchange in the donor lungs, lung ischemic time, early postoperative gas exchange, early postoperative mean pulmonary artery pressure, or frequency of early postoperative rejection. Severe postoperative hypotension occurred in five of eight patients with airway complications and in three of eight patients without airway complications.

Humans↗
PubMed1987

Two unusual causes of dysphagia: a pictorial essay.

Dysphagia was the presenting symptom in two adult patients. One had a mediastinal pancreatic pseudocyst, the other a pulmonary sling. The role of imaging methods in making the diagnoses is illustrated.

Adult↗
PubMed1986

Hepatic artery infusion chemotherapy with the Infusaid pump: a Canadian experience.

Hepatic artery infusion of 5-fluoro-2'-deoxyuridine (FUDR), utilizing the implantable "Infusaid pump", was used to treat 16 patients with diffuse hepatic metastases from colorectal carcinoma. Pump implantation was associated with minimal morbidity and no deaths. The pumps have now been in use for 190 treatment-months without serious complication. Six patients died of cancer between 3 and 26 months (mean 13 months) after insertion of the pump. Five died with recurrent disease outside the liver. Ten patients were alive 6 to 17 months (mean 12 months) after pump implantation. Follow-up ultrasonography in 13 patients documented regression of hepatic lesions in 7, no change in 4 and progression in 2. Regional perfusion chemotherapy can be instituted safely and treatment carries acceptable morbidity. Survival is prolonged relative to historic controls. Death ultimately occurs because of distant metastases. True assessment of the efficacy of this therapy demands prospective randomized trials of regional perfusion versus conventional therapy, with care to incorporate objective means of assessing quality of life during treatment.

Aged↗
PubMed1986

Esophageal obstruction secondary to a mediastinal pancreatic pseudocyst.

The authors report a rare complication of pancreatic pseudocyst. A 47-year-old man suffered rapidly progressing dysphagia and complete esophageal obstruction secondary to extrinsic compression by mediastinal extension of a pancreatic pseudocyst. Ultrasonography and especially computerized tomography were instrumental in diagnosis and in the planning of the operation. A posterior cystogastrostomy successfully drained the pseudocyst and relieved the esophageal obstruction.

Deglutition Disorders↗
PubMed1985

Delayed intestinal perforation after nonpenetrating abdominal trauma.

The incidence of hollow-organ injury has increased steadily since the use of seat-belts was introduced. It has become apparent that the clinical manifestations of intestinal injury may be delayed considerably. Delayed perforations can pose a diagnostic challenge to the attending surgeon. The authors report four patients who suffered delayed intestinal perforation 6 or more days after sustaining nonpenetrating abdominal trauma in motor vehicle accidents while wearing passive seat-belt restraints. All patients had low severity of injury (scores ranging from 4 to 13) but had persistent vague abdominal pain before perforation occurred. Three of the four patients suffered spinal trauma as their major initial injury. Such patients appear to be at higher risk for delayed perforation and should be monitored carefully.

Abdominal Injuries↗
PubMed1983

Femorofemoral bypass for temporary cardiac support in heart surgery.

Temporary femorofemoral bypass, combined with intra-aortic balloon pump counterpulsation, was used as a final resort to salvage the life of patients with extremely low cardiac output at the end of cardiopulmonary bypass and in patients who had cardiac arrest perioperatively who were unresponsive to conventional methods of resuscitation. Eight of 15 patients survived initially, 7 of them left hospital and remain well. These data are comparable to results obtained with the newly developed, but not readily available, left ventricular assist devices. The combination of femorofemoral bypass and intra-aortic balloon pump counterpulsation represents an important practical alternative as it can be used successfully for temporary cardiac support in critical situations, is potentially life-saving and is readily available at any cardiac centre at minimal cost.

Assisted Circulation↗
PubMed1983

Acute respiratory insufficiency from an aneurysm of the descending thoracic aorta.

A 70-year-old woman presented with life-threatening acute respiratory insufficiency resulting from tracheobronchial compression by a large calcified expanding aneurysm confined to the descending thoracic aorta. This combination has not previously been reported. Successful surgical correction was carried out. This report describes in detail the presentation, diagnosis, and steps involved in the management of this entity.

Acute Disease↗
PubMed1982

The cell saver during cardiac surgery: does it save?

Conservation and autotransfusion of autologous blood have been proposed as a means to decrease the homologous blood requirements of cardiac surgery. Use of the Haemonetics Cell Saver System to salvage blood shed in the sterile surgical field resulted in a net saving of 105 +/- 88.7 ml of packed red cells in 20 patients undergoing cardiopulmonary bypass. The system is not a cost-effective way to save blood or decrease homologous blood requirements during routine cardiac operations.

Adult↗
PubMed1978

Metabolism of the isolated perfused rabbit heart. I. Responses to anoxia and reoxygenation. II. Energy stores.

Cardiac performance, substrate utilization, and creatine kinase (CK) release were studied in Langendorff rabbit hearts during aerobic perfusion, 25 min of anoxia, and 75 min of reoxygenation. In study I (n = 40), increasing glucose availability during aerobic perfusion enhanced substrate utilization without influencing cardiac performance, and this effect was not modified by insulin. Reoxygenation with glucose decreased CK (milliunits per millilitre) in the coronary sinus effluent but the best early recovery occurred in hearts protected with the 'cocktail' (see Table 1) during anoxia and perfused with glucose and insulin during recovery. This early recovery of performance was associated with transient higher CK loss, an effect that may have been related to one or more of the following factors: squeezing out of interstitial CK, heterogeneous anoxic injury to the myocardium, severe sarcolemmal damage, and preferential energy utilization by the contractile apparatus. In study II (N = 82), increasing recovery of cardiac performance was associated with increasing rate of CK loss (milliunits per minute) during reoxygenation. At 15 min of recovery, creatine phosphate (CP) and ATP stores were 400 and 50% of the aerobic group suggesting the presence of a defect in energy transfer from CP to the cytosolic ADP:ATP system. Thereafter, CP levels gradually declined while ATP reached a peak concentration of 85% of the aerobic group at 30 min. By the end of recovery, ATP stores were low at 23% of control, at a time when cardiac performance and the rate of CK loss were maximal. The significance of these depleted ATP stores remains to be elucidated.

Adenosine Diphosphate↗
PubMedDate not supplied

Staging for M disease.

The presence of distant metastatic disease (M disease) in non-small-cell cancer patients is associated with a poor prognosis, and surgical resection at the primary site is contraindicated. Careful preoperative evaluation to identify the subset of patients presenting with M disease is essential in order to avoid unnecessary surgery. Current indications for the use of diagnostic techniques and the methods utilized to detect metastatic disease at the commonest sites encountered in patients with non-small-cell carcinoma, including the pleura, central nervous system, liver, adrenal glands, and skeletal system, are discussed.

Carcinoma, Non-Small-Cell Lung↗