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Biomedical subjects

T R Todd

Publications and source records attributed to T R Todd.

At least 73 records · Page 4Linked to original sources
PubMed1983

Reduction in local recurrence and improved survival in surgically treated patients with small cell lung cancer.

To assess the role of operation in the treatment and prevention of local recurrence in limited small cell lung cancer, we analyzed retrospectively 35 patients undergoing surgical resection for small cell lung cancer between 1976 and 1982. Twenty-eight patients underwent resection for presumed non-small cell histology. Seven later patients had planned combined modality therapy consisting of chemotherapy and prophylactic cranial irradiation followed by surgical resection and irradiation to the primary site. Twenty-four patients received adjuvant postoperative chemotherapy and/or radiotherapy. All patients have been treated and followed up for a minimum of 1 year. There were 19 patients in Stage I and 16 in Stages II and III. In 15 patients, relapse has occurred. The commonest site of first relapse was brain (7/15). Five of these patients had received prophylactic cranial irradiation. In only two patients was there a relapse locally in the hemithorax and/or mediastinum--one with NO disease and one with N1 disease. No local recurrence was noted in six patients with N2 disease. Only two relapses have occurred beyond 1 year--both in brain. In those patients surviving more than 2 years, no relapses have occurred. The median survival time for patients with Stage I disease is 158 weeks and for those with Stages II and III, 92.4 weeks. The median survival time for the whole group is 92.4 weeks with a projected 5 year survival rate of 24%. It appears that surgical resection may help to prevent local recurrence in small cell lung cancer, even in N1 and N2 disease. In our series, projected 5 year survival rates are similar to those seen in the surgical treatment of patients with non-small cell lung cancer. The eventual role of operation in the prevention of local recurrence and improvement in overall survival of limited small cell lung cancer awaits prospective randomized trials.

Adult↗
PubMed1983

Open window thoracostomy in the management of postpneumonectomy empyema with or without bronchopleural fistula.

Postpneumonectomy empyema, with or without bronchopleural fistula, remains an infrequent but serious complication of pulmonary resection. We reviewed our experience with the Clagett procedure in 31 patients with postpneumonectomy empyema. Seven had empyema alone and 24 had empyema with bronchopleural fistula. Ten patients died of metastatic disease without attempted closure of the thoracostomy window. In eight patients the total Clagett procedure was completed; window closure was permanent in two patients, but the remaining six had recurrence of empyema (four of whom had persistent occult fistulas). In eight further patients, persistent infection prevented attempted closure of the window. Five patients refused further surgical procedures. In only two of 31 patients were we able to achieve permanent closure of the thoracostomy window. Based on this experience, we conclude that open window thoracostomy provides adequate drainage and an excellent interim or permanent treatment of the infected pneumonectomy space. However, the presence of persistent bronchopleural fistula prevents successful completion of the total Clagett procedure. In our series, there were no deaths related to empyema or the surgical procedures performed for it.

Anti-Bacterial Agents↗
PubMed1983

One-stage reconstruction for pharyngolaryngectomy. Esophagectomy and pharyngogastrostomy without thoracotomy.

From 1969 to 1981, a total of 22 patients underwent laryngopharyngectomy and nonthoracotomy esophagectomy, with immediate pharyngogastrostomy, for hypopharyngeal or postcricoid carcinoma. Thirteen initially had been treated by high-dose radiotherapy, but the tumor had either persisted or recurred. Four patients underwent planned preoperative irradiation on the morning of the operation. Two patients had had previous high-dose local irradiation to the neck for other disease, and three patients had no irradiation. There was one operative death. Anastomotic leaks developed in four patients, but only one of the leaks was considered a serious problem. Three patients had transient dysphagia, but only one required dilatation. Transient delayed gastric emptying was a problem in three other patients. The average postoperative stay was 31 days, with 38% of patients being discharged by 21 days. All patients were discharged eating a normal diet. Fifty percent survived longer than 12 months, with an actuarial survival rate of 30% at 5 years. The patient surviving longest is disease free at 12 years. Palliation was considered excellent in all 21 operative survivors. Immediate pharyngogastrostomy via nonthoracotomy esophagectomy is a safe and excellent means of palliation in this group of patients, for whom palliation is often the only option.

Adult↗
PubMed1982

The value of adjuvant radiotherapy in pulmonary and chest wall resection for bronchogenic carcinoma.

Thirty-five patients, 29 men and 6 women, underwent pulmonary and chest wall resection for treatment of bronchogenic cancer which had extended into the chest wall. Anterior chest wall resection was performed in 6 patients, lateral resection in 2, and posterior resection in 27. Marlex mesh was employed as a prosthetic material in 13 patients. Radiotherapy was given as part of the planned therapeutic regimen in 13 patients. Three patients (8.5%) died in the postoperative period. There was 21 late deaths. Eleven patients are alive 7 months to 12 years after resection. The overall actuarial survival, including operative mortality, is 38% at 5 years. Actuarial survival of the 13 irradiated patients is 56% at 2 and 5 years. We believe that bronchogenic carcinoma with chest wall involvement is not hopeless, and that resection of the lung and chest wall can be performed with an acceptable mortality rate.

Aged↗
PubMed1981

Aspiration needle biopsy of thoracic lesions.

We reviewed our experience with 2,114 percutaneous aspiration needle biopsies of intrathoracic lesions. Aspiration was performed for cytological diagnosis employing biplane fluoroscopy and a 20 gauge needle, 0.9 mm in outside diameter. A satisfactory specimen was obtained in 88% of biopsies, and the chance of obtaining a correct diagnosis of a malignant lesion was 81.5%. The false positive rate was 2.3%, and the cytologists could always distinguish between primary and secondary neoplasms. A false negative rare of 13.6% (36 patients) resulted in only three delayed thoracotomies and two instances of interval metastases discovered at mediastinoscopy. Cellular specificity in primary tumors was not sufficiently accurate to affect therapy. Pneumothoraces occurred frequently (31.9% of patients) but wee generally small; 10.4% of patients required chest drainage. There were no recorded instances of tumor implantation in needle tracts. We conclude that a rapid and accurate diagnosis of intrathoracic pathology can be obtained by this technique. It is associated with an acceptable morbidity and may greatly expedite both patient care and investigation.

Biopsy, Needle↗
PubMed1981

Supradiaphragmatic ligation of the thoracic duct in intractable chylous fistula.

Spontaneous closure of a chylous fistula is usual, but the rare intractable fistula may lead to disastrous nutritional and immunological consequences. We report the surgical management of 5 patients with intractable fistulas with daily drainage averaging 2,060 ml. Conservative therapy failing, the 5 patients underwent 6 ligations of the thoracic duct. A limited posterolateral thoracotomy was used in 3, full right thoracotomy in 2, and left thoracotomy in 1. Ligations were carried out immediately above the diaphragm, and not at the fistula site, by a mass ligature technique encircling all tissue between the azygos vein and aorta. The ligation achieved immediate cessation of drainage in four of five initial procedures and in the fifth patient, at a second operation. High-output thoracic duct fistulas may be handled by supradiphragmatic ligation of the thoracic duct. Identification of the fistula site or the dissection of the thoracic duct itself is avoided by this technique.

Aged↗
PubMed1981

The palliative value of surgical resection for carcinoma of the esophagus.

The authors review their experience with primary resection for carcinoma of the esophagus and compare the palliative results with those of a recently reported series of similar patients treated with radiotherapy alone. Between 1971 and 1977, 104 patients with carcinoma of the esophagus underwent resection as the primary therapy. The operative mortality was 7.7% (1.7% in the latter half of the series). At least 80% of the 104 patients had complete, continuing palliation of their dysphagia. Radiotherapy in a similar group of patients reported resulted in an 8% mortality from complications of the treatment and there was local recurrence of the tumour, usually associated with dysphagia, in 80%. The authors conclude that the palliation achieved with surgical resection is substantially better than that achieved with radical radiotherapy applied to a similarly staged group of patients with carcinoma of the esophagus.

Adenocarcinoma↗
PubMed1981

Prospective, randomized, double-blind study using prophylactic cephalothin for major, elective, general thoracic operations.

A total of 211 patients were entered into a randomized, double-blind study of postoperative infection in which an antibiotic (cephalothin) and a placebo were used. The antibiotic was effective in reducing sleep wound infections (p less than 0.05) and superficial wound infections (p less than 0.01). The incidence of pulmonary infections was decreased, but the change was not statistically significant, and the incidence of empyema was unaffected.

Bacterial Infections↗
PubMed1981

Use of the silicone tracheal T-tube for the management of complex tracheal injuries.

This paper reports on the use of the silicone Montgomery T-tube for the management of 18 patients with complex tracheal injuries. Our use of the tube was as follows: prior to definitive resection, as a better alternative to tracheostomy tube, while we were awaiting the most appropriate time for resection; at the time of resection, as an adjunct to segmental subglottic resection, used to stent residual abnormal laryngeal mucosa: following tracheal resection for uncertain or unsatisfactory healing: as sole treatment, when resection was deemed unsuitable or inappropriate. When stenting the high region, the upper limb of the T-tube can be brought through the vocal cords with preservation of a functional voice and without injury to the vocal cords even with prolonged use. In contrast to a tracheostomy tube, the T-tube provides respiration through the the nasopharynx, so that humidification and phonation are maintained. It is generally trouble free, requires little if any maintenance, and can remain in place for a year or more when necessary.

Adolescent↗
PubMed1981

Developmental bronchopulmonary disease in adults: practical clinical considerations.

Developmental abnormalities of the tracheobronchial tree and its vascular components may be seen in both pediatric and adult patients. These abnormalities occur as pure bronchial anomalies (in which the vascular organization is normal), as pure vascular anomalies (in which the bronchial arborization has proceeded normally) or as combined bronchial and vascular anomalies. The clinical syndromes associated with these anomalies may usefully be considered together as different aspects of potential failure of bronchovascular development. In the adult the bronchogenic cyst is the most commonly encountered pure bronchial abnormality, arteriovenous malformation the commonest pure vascular anomaly and sequestration the most frequent mixed defect. Between 1958 and 1978, 32 bronchogenic cysts, 14 sequestrations and 18 parenchymal aneurysms were treated at the Toronto General Hospital. Diagnostic and therapeutic considerations suggest that surgical intervention is warranted in most cases.

Adolescent↗
PubMed1980

The management of nonmalignant intrathoracic esophageal perforations.

Eight patients with nonmalignant intrathoracic esophageal perforations recognized more than 48 hours (48 hours to 14 days) after rupture were treated at Toronto General Hospital between 1973 and 1978. Perforation was due to postemetic rupture in 7 patients and to instrumentation in 1. The patients were seen with pain (8), vomiting (7), fever (7), shock (4), respiratory insufficiency (5), pleural effusion (7), pulmonary infiltrates (7), and leukocytosis (6). All patients were managed with thoracotomy. Direct suture closure of the perforation was carried out in 4 patients with midesophageal perforations. Postoperative localized leaks developed in 2 of these patients but healed with conservative management. Cervical esophagostomy and esophageal diversion were used in 1 patient in whom a severe empyema developed in the postoperative period. Direct suture closure, reinforced with a gastric patch, was used to close three lower esophageal perforations. None of these patients had a postoperative leak but all developed subsequent reflux esophagitis. All 8 patients survived. In patients with delayed recognition of a nonmalignant intrathoracic esophageal perforation, elimination of continued chemical and bacterial contamination can be achieved by a clear definition and closure of the esophageal mucosal margins. The obliteration of potential pleural spaces by good tube drainage, lung decortication, and the elective use of mechanical ventilation with positive end-expiratory pressure decreases the incidence of uncontrolled intrapleural sepsis.

Adult↗
PubMed1980

Bronchial carcinoid tumors: twenty years' experience.

We reviewed 69 patients with documented carcinoid tumors, 67 of whom had resectable disease. Operations included nine pneumonectomies, 31 lobectomies, 12 bilobectomies, five segmental resections, and 10 sleeve resections. Follow-up on 65 patients reveals 40 surviving beyond 5 years and 13 beyond 20 years since resection. There were no operative deaths and only one recurrence (local) that was subsequently successfully resected. Twenty patients had had recurrent unifocal pneumonitis or hemoptysis for up to 5 years prior to diagnosis. Two patients had the carcinoid syndrome. Biopsy was performed on 23 tumors and resulted in "moderate-to-severe" hemorrhage in six cases. Lymphatic spread was present in seven cases. All seven are alive and free of disease, six of whom have been followed from 5 to 24 years. Diseased resection margins were present in two cases, with both surviving 20 years after resection. All 10 sleeve resections were performed more than 5 years ago. We conclude that carcinoid tumors carry a favorable prognosis upon resection, even when intrathoracic lymphatic metastases are present and are resected. Lung-sparing resections including sleeve resections should be utilized. Recurrent pneumonia or hemoptysis or both requires diligent investigation. Biopsy of the tumors may be performed with care.

Bronchial Neoplasms↗
PubMed1979

Sleeve lobectomy for carcinoma of the lung.

Sleeve lobectomy for non-oat cell carcinoma involving a major bronchus preserves functioning lung tissue and, in carefully selected patients, provides long-term survival comparable to pneumonectomy. Seventy patients underwent sleeve lobectomy between 1967 and 1978. Twenty-seven patients were considered compromised (Group I) because they had severe respiratory impairment which contraindicated pneumonectomy. Forty-three patients were considered uncompromised (Group 2) and underwent elective sleeve lobectomy. Seventy patients with a similar non-oat cell carcinoma involving the proximal bronchi underwent pneumonectomy (Group 3) during this period. Perioperative complications occurred more frequently in Group 1 (59%) than in Group 2 (21%) or Group 3 (23%). Both periopeative mortality rate and the incidence of bronchial disruption (bronchovascular and bronchopleural fistulas) were higher in Group I (19% and 22%) than in Group 2 (9% and 5%) or Group 3 (3% and 7%). Survival depended primarily on the surgeon's ability to perform a complete resection of the tumor. An incomplete resection resulted when tumor was found in the highest lymph node or in the last bronchial resection margin when paraffin sections were reviewed. The 5 year survival rate was 18% for compromised patients (Group 1) who underwent complete resection, and there were no survivors among patients undergoing incomplete resections. Uncompromised patients ( Group 2) had a 5 year survival rate of36% with complete and 12% with incomplete resections. Pneumonectomy patients (Group 3) had a 64% 5 year survival rate with a complete resection and 16% with an incomplete resection. The stage of the disease at the time of operation had a profound effect on the survivail. There was no difference inthe 5 and 8 year survival rates between uncompromised patients undergoing sleeve resection ( Group 2) and patients undergoing peneumonectomy (Group 3) for comparable stage of their disease. A careful pre- and postoperative functional assessment revealed that pulmonary performance was improved in 44% of Group 1, 63% of Group 2, and only 14% of Group 3 patients. Patients wiht impaired pulmonary reserve underwent sleeve lobectomy with an adequate disease-free interval when complete tumor excision was possible. Uncompromised patients whose extensive disease required incomplete resection had palliation by sleeve lobectomy equivalent to that by pneumonectomy. When complete t-mor resection was possible, patients with uncompromised pulmonary reserve had a perioperative complication rate and long-term survival equivalent to that of pneumonectomy while preserving pulmonary parenchyma, which permitted an improvement in postoperative pulmonary performance.

Adenocarcinoma↗