Search PubMed⌕ Search

Biomedical subjects

T R Todd

Publications and source records attributed to T R Todd.

At least 55 records · Page 3Linked to original sources
PubMed1987

Significance of metastatic disease in subaortic lymph nodes.

Thirty-five patients underwent resection of primary bronchogenic carcinoma of the left upper lobe or left main bronchus in the presence of metastatic disease in subaortic lymph nodes. No patient had metastatic disease in other mediastinal node stations. There was 1 postoperative death. Complete follow-up is available on 34 patients. Three-year and five-year actuarial survival for the entire group is 44% and 28%, respectively. For 23 patients undergoing complete resection, five-year actuarial survival is 42%. Resection of primary bronchogenic carcinoma in the presence of subaortic nodal metastases is associated with improved survival relative to reports of survival following resection of metastatic disease in other mediastinal node stations. Resection should be undertaken in these patients especially when it is judged that the resection is likely to be complete.

Adult↗
PubMed1987

Tube drainage of lung abscesses.

We treated 14 patients who had complicated lung abscesses (all over 4 cm in diameter); 9 patients had concomitant respiratory failure requiring mechanical ventilation. A percutaneous tube was inserted in 11 patients (3 subsequently underwent rib resection) and 3 underwent rib resection with operative insertion of the tube. The resultant bronchopleural fistulas did not interfere with respiratory management despite the use of mechanical ventilation, and only 2 patients required subsequent surgical closure. Eleven patients were discharged from the hospital. Complications were minimal and consisted of 2 episodes of hemorrhage, 1 during operative debridement of the abscess and 1 delayed. Both complications were managed successfully. Three patients died in the hospital, only 1 from complications of the lung abscess. We have concluded from this review that tube drainage can be safe, simple, and efficacious. We recommend it for the treatment of complicated lung abscesses even when associated with respiratory failure and mechanical ventilatory support.

Bronchial Fistula↗
PubMed1987

Gastroplasty and fundoplication for complex reflux problems. Long-term results.

Between 1964 and 1984, 430 patients with complex reflux problems were managed by a modified Collis gastroplasty and partial fundoplication. The indications for selecting the addition of gastroplasty were as follows: (1) obvious acquired shortening due to peptic esophagitis and stricture, and (2) subtler degrees of acquired shortening frequently encountered in cases that required reoperation and in patients with massive sliding hiatal hernia. The addition of gastroplasty in this second group obviates the risk of even minimal tension on the repair. Follow-up is complete in 382 patients (90%), and extends 1-20 years. Two hundred fifty patients have been followed up for 5 or more years and 101 patients for more than 10 years. Results were classified as follows: good: asymptomatic, or inconsequential symptoms requiring no therapy; fair: improved, but with symptoms and/or endoscopic findings requiring intermittent therapy; poor: unimproved or worse. Patients are divided into four categories, and the results are tabulated below (see Table 2). The best results are obtained in patients with acquired shortening due to esophagitis with and without stricture who have had no prior antireflux surgery and have no associated primary motor disorder. The proportion of unsatisfactory results is almost tripled (20% fair or poor) after reoperation after one or more failed antireflux procedures. When reflux esophagitis and stricture are associated with a primary motor disorder, only half of the patients have a good result sustained throughout long-term follow-up.

Adenocarcinoma↗
PubMed1987

Technique of successful lung transplantation in humans.

We have performed five single lung transplantations for end-stage pulmonary fibrosis, with four long-term survivors. Two patients underwent right lung transplantation and two underwent left lung transplantation. The procedure is performed with one lung anesthesia, although cardiopulmonary bypass is available on standby if required. Donor and recipient procedures are performed in adjacent operating rooms. On the basis of laboratory studies, a pedicle of omentum is wrapped around the bronchial anastomosis after its completion to restore bronchial artery circulation and protect the anastomosis. The four patients were discharge from the hospital within 4 to 6 weeks and three returned to normal employment at 3 months. Success in these cases is attributed to careful patient selection, use of cyclosporine, and use of an omental pedicle to protect and improve healing of the bronchial anastomosis.

Cyclosporins↗
PubMed1987

Experimental gram-negative pneumonia produces a hyperdynamic septic profile.

General anesthesia (GA) and extensive surgery undertaken to reproduce a hyperdynamic septic shock syndrome (HSSS) may confound the observed effects of pure HSSS. A large animal model of HSSS without GA or surgery was created in sheep following production of a Pseudomonas pneumonia by direct bronchoscopic instillation into a dependent lobe using only light ketamine anesthesia. Cardiac output rose significantly (5.05 to 6.32 L/min) while SVR [1,421.4 to 1,000.5 dynes X s X cm(-5)] and mean BP (92.5 to 82.0 mmHg) fell in the septic animals. Systemic infection was confirmed by blood culture. This model reliably produces hyperdynamic sepsis without the confounding effects of GA or extensive surgery.

Animals↗
PubMed1987

A prospective evaluation of magnetic resonance imaging, computed tomography, and mediastinoscopy in the preoperative assessment of mediastinal node status in bronchogenic carcinoma.

Computed tomography, magnetic resonance imaging, chest roentgenography, and mediastinoscopy were compared prospectively as staging modalities to assess mediastinal node status in 84 patients with presumed operable bronchogenic carcinoma. Computed tomography was associated with a sensitivity of 71.0%, a specificity of 87.7% and an overall accuracy of 82.1%. Magnetic resonance imaging did not provide any advantage over computed tomography in the assessment of mediastinal node status. The accuracy of computed tomography was not dependent on cell type of the primary tumor. Although chest roentgenography had a sensitivity of 80.7%, the overall accuracy of 57.1% was unacceptably low. The sensitivity (87.1%), specificity (100%), positive (100%) and negative (93.0%) predictive values, and accuracy (95.2%) of mediastinoscopy exceeded those observed with all other modalities. We continue to recommend mediastinoscopy as the most accurate staging investigation in the routine management of patients with bronchogenic carcinoma.

Carcinoma, Bronchogenic↗
PubMed1986

Precision cautery excision of pulmonary lesions.

We have used a cautery dissection technique, initially described by Perelman, to facilitate nonanatomical pulmonary resections in certain instances in which the anatomical location of the lesion made wedge excision by standard methods difficult or impossible. With the precision cautery technique, the raw surface of the lung is left charred and allows minimum or no air leakage following the procedure. We have found this method a useful addition to existing techniques for pulmonary resection.

Electrocoagulation↗
PubMed1986

Effect on cardiopulmonary changes of gram-negative endotoxemia in sheep after type-specific, cross-reactive, and nonspecific immune stimulation.

The purpose of this study was to examine the effects of prior nonspecific immune stimulation (BCG), cross-reactive immunization (E coli J5 0111 whole cells [J5 WC], and core glycolipid [J5 CGL]), and type-specific immunization (Serratia marcescens core glycolipid [SM CGL]) on the cardiopulmonary variables and white blood cell counts of awake, monitored sheep following IV Serratia marcescens endotoxin. Comparison of cardiac output, pulmonary artery pressure, pulmonary capillary wedge pressure, pulmonary vascular resistance, alveolar-arterial oxygen gradients, and total white blood cells lead us to conclude that type-specific immunization (SM CGL) most effectively ameliorates the changes of gram-negative endotoxemia contrasted to nonimmunization. Core glycolipid cross-reactive (J5 CGL) immunization was somewhat more effective than whole-cell cross-reactive (J5 WC) immunization in this regard. Nonspecific immune stimulation (BCG) was able only to significantly decrease the changes in pulmonary vascular resistance compared to nonimmunization.

Animals↗
PubMed1986

Systemic candidiasis in a surgical intensive care unit.

Treatment for systemic candidiasis has often been withheld because of the nephrotoxicity of standard amphotericin B therapy, particularly in immunodepressed patients. The authors describe their experience between 1981 and 1983 with 29 such patients in the intensive care unit who were treated with low-dose amphotericin B. The diagnosis was made when endophthalmitis or persistent fungemia was present, or when Candida was cultured from three or more body sites. The daily dose of amphotericin B was 0.3 to 0.5 mg/kg. Treatment was accompanied by a mean increase in the serum creatinine value of 26% in patients who did not undergo dialysis before therapy, but this did not lead to renal failure. The overall death rate was 72.4%. Non-survival appeared to be associated with an inadequate total dosage (less than 6 mg/kg); survivors received a mean total dose of 570 mg. A retrospective analysis of positive peritoneal cultures failed to support their previously reported significance. The authors conclude that, in some instances, low-dose amphotericin B will effectively treat systemic candidiasis, resulting in little renal impairment, and that the criteria for such treatment require re-evaluation.

Adult↗
PubMed1986

Prospective evaluation of mediastinoscopy for assessment of carcinoma of the lung.

Between 1979 and 1984, mediastinoscopy was performed on 1,000 of the 1,500 patients admitted to the Thoracic Surgical Service of the Toronto General Hospital with the diagnosis of carcinoma of the lung. In 144 cases, concomitant anterior mediastinoscopy was also performed. Abnormal mediastinal nodes were found in 296 (29.6%). The overall complication rate was 2.3%, with no deaths. Mediastinoscopy revealed diseased nodes in 24% of patients with squamous cell carcinoma, 29% with adenocarcinoma, 54% with small cell undifferentiated carcinoma, 31% with large cell undifferentiated carcinoma, and 12% with bronchoalveolar carcinoma. Abnormal mediastinal nodes were found with equal frequency in right- and left-sided tumors and occurred in 31% of tumors in the main bronchus, 25% of upper lobe tumors, and 17% of lower lobe tumors. Of the 704 patients having negative results of mediastinoscopy, 590 were subjected to thoracotomy. Ninety-three percent underwent resection (85% curative, 7% palliative) and 7% had unresectable tumors. Of the resections, 20% were pneumonectomies. At thoracotomy, 52 of the 590 patients with negative mediastinoscopic results were found to have abnormal mediastinal nodes. Sixty-two of the 296 patients with positive results of mediastinoscopy were selected for thoracotomy. Eighty-six percent had resectable lesions (67% curative, 18% palliative) and 14% unresectable. The pneumonectomy rate in this group was 35%. These current data support our previous opinion that routine mediastinoscopy can be done with negligible morbidity and provides essential information for the classification and management of cancer of the lung.

Adenocarcinoma↗
PubMed1985

Radiotherapy alone for patients with operable carcinoma of the lung.

Between 1966 and 1980, 72 patients with operable carcinoma of the lung were treated primarily with radiotherapy because coexisting, nontumor related medical problem, or patient refusal prevented thoracotomy. We compared results obtained in this group with results obtained by thoracotomy in 123 consecutive patients over the age of 70, who were assessed in a similar fashion, but who underwent thoracotomy. All patients in both groups had proven, nonsmall cell carcinoma of the lung without clinical, laboratory, or radiologic evidence of tumor spread. All patients in both groups had a negative staging mediastinoscopy, and bronchoscopic findings consistent with operability. Many of the patients treated with radiotherapy had less than a curative dose as their general medical condition prevented a course of radical radiotherapy. It is apparent, however, that the results of radiotherapy for patients with operable carcinoma of the lung may be disappointing and that for patients who are marginal in terms of operative risk, the benefits of surgical resection may warrant the risks involved.

Actuarial Analysis↗
PubMed1985

Hypovolemic shock.

Hypovolemic shock is the most common form of shock seen clinically and has attracted the greatest laboratory interest. It is caused by a sudden decrease in the intravascular blood volume relative to the vascular capacity, to the extent that effective tissue perfusion cannot be maintained. The authors of this article discuss the pathophysiology of hypovolemic shock, the assessment of the patient in shock, the immunologic consequences of shock, impairment of cardiac function in hypovolemic shock, and the management of hypovolemic shock.

Body Fluids↗
PubMed1984

Effects of immunization on cardiopulmonary alterations of gram-negative endotoxemia.

We studied the effects of an infusion of Serratia marcescens endotoxin on hemodynamic function, white blood cells, platelets, and the plasma levels of thromboxane B2 (TXB2) and 6-ketoprostaglandin F1 alpha (6-keto-PGF1 alpha) in awake monitored sheep. The animals were immunized using the core glycolipid (CGL) fraction of Escherichia coli J5 0111. An additional group of animals was studied after passive transfer of immune serum from the actively immunized CGL animals. Active immunization with CGL was effective in preventing the hematologic and hemodynamic changes as well as the elevations in TXB2 and 6-keto-PGF1 alpha seen during gram-negative endotoxemia. Passive immunization also reduced some of the deleterious effects of endotoxin infusion but was less effective than active immunization. This study demonstrates the potential of cross-specific immunization to protect against the cardiopulmonary alterations caused by gram-negative endotoxemia.

6-Ketoprostaglandin F1 alpha↗
PubMed1984

Experience with primary neoplasms of the trachea and carina.

From 1963 to 1983, 44 patients presented with a primary tracheal neoplasm that was amenable to surgical treatment. Forty-two of the 44 tumors were malignant. Thirty-three patients were managed by resection and primary anastomosis. The following resections were done: trachea only, 12; trachea plus carina, 13; trachea plus cricoid cartilage, four; and trachea plus larynx, four. There were two operative deaths in these 33 patients. Prosthetic reconstruction with heavy-duty Marlex mesh was done in six patients. Three of the six died of erosion of the innominate artery during the postoperative period. In three patients with nonresectable tumors, a silicone-coated Montgomery T-tube provided transient but worthwhile palliation. In two patients with nonobstructive adenoid cystic carcinoma involving the subglottis, irradiation was chosen as the initial treatment, since resection would necessitate laryngectomy. Resection, including laryngectomy, may be required in the future. The following points are emphasized: (1) A majority of operable neoplasms can be resected through a cervical collar incision and median sternotomy. Median sternotomy is the optimal operative exposure in most neoplasms necessitating resection of the carina. (2) Partial resection of the cricoid with sparing of the recurrent laryngeal nerves and larynx is possible in some patients with primary malignant tumors involving the proximal trachea and subglottic region. (3) In patients with adenoid cystic carcinoma, resection may afford excellent, long-term palliation even when the resection is incomplete. Pulmonary metastases are common in patients with adenoid cystic tumors. However, they usually progress slowly, may remain asymptomatic for many years, and are not necessarily a contraindication to resection of the primary tumor even when they are synchronous. Our experience suggests that adjunctive radiotherapy is beneficial in patients with adenoid cystic carcinoma.

Anesthesia, Endotracheal↗
PubMed1984

Results of surgical treatment for thymoma.

Ten years' experience with surgical treatment of thymoma in 52 patients is reported, 25 patients with myasthenia gravis and 27 without. Twenty-five patients had noninvasive tumors (Stage I) and 27 had invasive tumors (Stages II and III). Of the 52 patients, 29 had surgical resection as the only treatment and the remaining 23 had surgical resection with adjunctive preoperative or postoperative radiotherapy. Currently, 39 patients are alive (20 with myasthenia and 19 without), 10 are dead (none dying of myasthenia or tumor), and three patients have been lost to follow-up. The mean follow-up time for all patients was 5.6 years. There were no operative deaths in this series. The 5 year cumulative survival rate for the entire group of 52 patients is 81%; for patients with myasthenia it is 92%; and for those without myasthenia, 71%. This series suggests that the prognosis following resection of thymoma relates primarily to the stage of the tumor and is not significantly influenced by the presence or absence of coexisting myasthenia gravis. The improved survival rate, in contrast to a 1973 report, is a reflection of improved long-term medical management of myasthenia gravis and better postoperative supportive care.

Female↗
PubMed1983

A controlled trial of the effect of parenteral nutritional support on patients with respiratory failure and sepsis.

Energy and protein metabolism was studied in 11 septic patients receiving ventilatory support while on three different intravenous regimens. They received 5% dextrose in water (D5W), and one of two different regimens of parenteral nutritional support (PNS); either amino acid and dextrose (PNA) or amino acid and dextrose and lipid (PNB). All patients were given D5W and PNS in random order. The energy intake was targetted to exceed by 50% the measured metabolic rate. On D5W the mean measured energy expenditure was only 15.2% above the expected energy expenditure (p<0.02). A respiratory quotient of 0.75 while on D5W showed that in the absence of PNS the major part of energy requirements came from fat oxidation. In addition, on D5W these patients were in negative nitrogen and protein (synthesis-catabolism) balance. With PNS the metabolic rate rose significantly (p<0.02). While on PNA, the CO2 production was significantly higher than with PNB, and despite receiving all non-protein energy as glucose, the patients continued to oxidise fat to meet about 30% of their energy requirements. Continued fat oxidation was found to be associated with insulin resistance and high catecholamine levels, suggesting a cause and effect relationship. PNS caused an increase in protein (synthesis - catabolism) and nitrogen balances, and reduced leucine oxidation. The fall in leucine oxidation was greater on PNB than on PNA. Protein and nitrogen balances, expressed per gram of amino acid infused, were significantly better with PNB than PNA. It was concluded that insulin resistance may make fat an efficient source of energy.

Journal Article↗
PubMed1983

Massive hiatal hernia with incarceration: a report of 53 cases.

Between 1960 and 1980, 53 patients with massive incarcerated hiatal hernia were treated surgically. In 24 of the 53 patients, there was an associated organoaxial volvulus. The following symptoms and signs, which are almost peculiar to massive, incarcerated hernias, were observed: postprandial precordial distress in 43 patients, upper gastrointestinal bleeding (manifest or occult) in 24 patients, severe dyspnea in 13 patients, and complete obstruction associated with organoaxial volvulus in 4. In only 1 of the 53 patients was the hernia of the true paraesophageal type with the esophagogastric junction remaining in its normal, intraabdominal location. The remainder were all believed to be advanced stages of an ordinary sliding hiatal hernia. Operative treatment consisted of gastroplasty and partial fundoplication in 36 patients, standard Belsey repair in 14, and transabdominal Nissen repair in 3. Gastroplasty and partial fundoplication were used much more frequently during the 1970s, when it was realized that there is a significant incidence of chronic peptic esophagitis and shortening in these patients. Postoperative complications were few in spite of the advanced age of many of the patients. There was one operative death. Only 1 patient was lost to follow-up, and of the 51 patients remaining for analysis, follow-up has extended from 1 to 16 years, with a mean of 6.2 years. No patient has developed recurrent precordial pain, evidence of upper gastrointestinal bleeding, iron deficiency anemia, or severe dyspnea. Seven patients have residual dysphagia; this condition is minimal in 5, and is significant in 2 who require interval esophageal dilation. Nine patients have symptomatic reflux, which is minimal in 5 patients, moderate in 2 patients, and severe in 2 others who were subsequently reoperated on. Contrary to popular concept, our observations indicate that almost all of these patients represent advanced degrees of sliding hiatal hernia with intrathoracic displacement of the esophagogastric junction. This implies a need for an adequate antireflux reconstruction in all patients undergoing operation, as well as an awareness that unanticipated cicatricial changes may be present in the distal esophagus and may prejudice the success of some of the standard hiatal repairs.

Adult↗