H Toomes

Katholisches Klinikum Koblenz - Montabaur, Montebaur, Rheinland-Pfalz, Germany

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Publications (73)78.4 Total impact

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    ABSTRACT: As video-assisted thoracoscopic surgery has been performed for more than five years an inquiry was made to register and if possible to evaluate different pleurodesis procedures in the treatment of pneumothorax in Germany. 19 institutions provided information about 1365 operations. Overall there were 88 recurrences (6.5%). 26 (1.9%) severe bleeding complications or hemothorax and 39 (2.9%) persisting air leaks required further interventions. There were two (0.1%) hospital deaths. Recurrence rates showed a significant (p < 0.001) correlation to the type of pleurodesis used. Talcum pleurodesis had no recurrences and fibrin glue pleurodesis had the highest rate of recurrence (16.4%) both procedures being less frequent. After causal treatment, i.e. resection without any pleurodesis, recurrence rate is inconsistent and was 10.2% overall. Pleural abrasion was followed by a recurrence rate of 7.9% and pleurectomy of 4.4%. Both procedures induced significantly (p = 0.01) more bleeding complications (about 3%) than other procedures (0.4%). Promising was coagulation of the pleura parietalis with a recurrence rate of only 2.7% and a low rate of complications.
    The Thoracic and Cardiovascular Surgeon 09/1996; 44(4):199-203. · 0.93 Impact Factor
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    ABSTRACT: An ex-vivo isolated, perfused, and ventilated human lung (IPHL) model is well suited for many kinds of physiological, pharmacological, and surgical studies, when the physiological and biochemical conditions in the lung can be maintained near to those in vivo. The aim of this work was to develop such a model. The lung preparations used were available after resection because of bronchial carcinoma. Since the tumor remains intact in these anatomical preparations, this model is particularly suitable for investigation of the pharmacokinetics and effects of anticancer agents. Carrying out a series of 52 IPHL experiments (with 11 whole-lung preparations and 41 lobe preparations), we have established an IPHL model which allows extracorporeal perfusion and ventilation of the resected lungs in physiological conditions for 2-3 hours. The net weight gain during the experiment, wet-to-dry weight ratio for lung tissue, angiography of the pulmonary artery, pulmonary vascular resistance, color and fluorescence of the lung surface, and alveolar gas diffusion into the perfusate proved to be useful parameters to assess the stability of the preparations and the quality of the experiments. To confirm that an intraparenchymal tumor was perfused via the pulmonary artery, methods to detect avidin and dextran-biotin in tumor tissue after administration into the perfusion solution were employed. Histological examination of bronchial as well as tumor tissue, a computerized histoanalyzation, and a tumor grading program demonstrated that IPHL experiments did not interfere with the grading and staging of the tumors-an important ethical precondition for the use of human preparations in an extracorporeal perfusion model.
    The Thoracic and Cardiovascular Surgeon 07/1996; 44(3):140-6. · 0.93 Impact Factor
  • G. Friedel, H. Toomes
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    ABSTRACT: GrundlagenQualitätssicherung ist ein Schlagwort, das von verschiedenen Gruppen in unterschiedlicher Zeilsetzung gebraucht wird. Die „Deutsche Gesellschaft für Thoraxchirurgie” (DGT) hat 1989 eine Kommission für Qualitätssicherung eingesetzt, um eine Qualitätssicherungsmaßnahme für die Thoraxchirurgie zu konzipieren. MethodikIn den Pilotphasen 1992 und 1993 wurden ein Datenpool für die externe Qualitätssicherung und ein Rahmenkonzept für die interne Qualitätssicherung ausgearbeitet. ErgebnisseDie externe Qualitätssicherung baut auf einem behandlungsbezogenen Indikator, der Gesamtheit aller Thorakotomien und Stermotomien, auf. Der Einsatz sogenannter Tracer-Diagnosen erscheint in der Thoraxchirurgie nicht sinnvoll, da auch die korrekte Behandlung seltener Erkrankungen ein wesentliches Qualitätsmerkmal spezialisierter Abteilungen darstellt. SchlußfolgerungenAufgrund der Erfahrungen der Pilotauswertung 1992 wurden 5 Qualitätskriterien als Auswertungsgrundlage ausgewählt. Die Kriterien stehen in bezug zu Risikogruppen, Operationsarten, Tumorstadien, Erkrankungen und präoperativen Untersuchungen. Für die Mehrzahl dieser Kriterien existieren noch keine Standardvorgaben. Es werden als Qualitätsanforderungsprofile Toleranzbreiten angegeben. Die Qualitätsdokumentation beinhaltet Daten zu Untersuchungen, zur Risikoeinschätzung, operationsrelevante Daten und intraund postoperative Komplikationen. Die Auswertung erfolgt anonymisiert durch eine von der DGT ausgewählte Abteilung. Für die interne Qualitätssicherung werden Rahmenrichtlinien zu Einzelfallanalysen und Auswertungen sowie Qualitätsverbesserungen vorgegeben. Die erforderlichen Gremien für die Durchführung der Qualitätssicherungsmaßnahmen werden von der DGT eingesetzt. Die letzte Instanz für eventuelle Beratungen oder Sanktionen ist der Vorstand der DGT. BackgroundQuality assurance (QA) is a catchword used by different groups with different objectives. In 1989 the German Society of Thoracic Surgery established a committee on QA to design measures for QA in thoracic surgery. MethodsIn the pilot periods of 1992 and 1993 a data pool for external QA and a basic concept for internal QA was elaborated. ResultsExternal QA is based on a therapy-related indicator, thoracotomies and sternotomies. The application of tracer-diagnoses does not seem to be useful in throacic surgery, since adequate therapy of rare diseases represent important quality features of specialized departments. ConclusionsOn the basis of experiences 5 criteria were selected as basis of evaluation. They are related to risk groups, surgical methods, tumor stages, diseases and preoperative investigations. So far there are no standard data for most of these criteria. As quality demand profiles tolerance ranges are given. Quality documentation includes data on investigations and risk evaluation, surgical relevant data and intra- and postoperative complications. Evaluation is realized on an anonymous basis by department determined. Basic guidelines for single-case analyses and quality improvements are given. The committees necessary for the implementation of QA are employed by the society. Final authority for possible recommendations is the Society board.
    European Surgery 02/1996; 28(2):116-120. · 0.15 Impact Factor
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    ABSTRACT: From 1990 through 1992, 70 patients 70 years of age or older (mean 72.8 years) underwent surgery for lung cancer at our hospital (47 males/23 females). 68 patients took part in a follow-up. Operative treatment consisted of standard lung resections in 42 cases. 17 patients underwent enlarged resections. In the postoperative period, complications occurred in 32 cases (47%). The overall operative mortality rate of 13% was mainly due to concomitant cardiovascular diseases and enlarged lung resections. Critical preoperative evaluation of the patients' functional status and selection of the proper operative procedure promise a successful treatment of lung cancer in the elderly.
    Langenbecks Archiv für Chirurgie. Supplement. Kongressband. Deutsche Gesellschaft für Chirurgie. Kongress 02/1996; 113:824-7.
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    ABSTRACT: Intraoperative lymph node staging plays an essential part in the surgical treatment of lung cancer. The mean number of resected lymph nodes in 237 patients was 17, with a minimum of 1 and a maximum of 60. The largest number was found in N1 regions as expected. The number of resected nodes in the paratracheal, tracheobronchial and subcarinal region was 4, in the paraoesophageal and ligament region 1.2. Twenty-two percent of the whole group showed an N2 situation. In 45% of the patients with N2 invasion, we found a lymph node skipping and in 25% only one positive N2 node. Thus, it is obvious that without a systematic lymph node dissection an exact staging is not possible.
    Langenbecks Archiv für Chirurgie. Supplement. Kongressband. Deutsche Gesellschaft für Chirurgie. Kongress 02/1996; 113:785-9.
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    ABSTRACT: An enormous pulmonary cyst (phi approx. 20 cm) in a 72-year-old male patient with large bullous pulmonary emphysema caused compression of the right lung and the mediastinum with consecutive, O2-dependent dyspnoea at rest. The symptoms did not improve under conservative therapy of an accompanying COPD. Thus, in spite of two heart attacks in the previous history, an operation with bullectomy was indicated. A thoracotomy had to be avoided because of the very high cardiac risk. In the present case, a minimally invasive procedure enabled the complete cyst resection with a smooth postoperative course and an excellent functional therapeutic result.
    Pneumologie 04/1995; 49(3):236-8.
  • A Linder, G Friedel, H Toomes
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    ABSTRACT: Video-assisted thoracoscopic surgery is viewed as a sparing and safe alternative to thoracotomy for a wide spectrum of benign thoracic diseases. However the loss of palpation as well as the insufficiency of complete mediastinal lymphadenectomy are responsible for the uncertainty of the new method concerning curative oncological therapy. During the last two years we could replace thoracotomy by operative thoracoscopy in nearly all cases of recurrent pneumothorax and recurring pleural effusion. In a series of 447 endoscopic operations in 350 patients following distinct indications and strong prerequisites in terms of operating team and infrastructure of our department we could establish a high standard for this new operating method. The good postoperative results of this large series of thoracoscopic operations indicate the high rank of this new technique in thoracic surgery. Recurrence rates of 1.5% for pneumothorax surgery and 0 for pleurectomy for malignant pleural effusion can be compared to those in open thoracic surgery. Six weeks after the operation the postoperative lung function was normal in 80% of an initial group of patients.
    Der Chirurg 09/1994; 65(8):687-92. · 0.52 Impact Factor
  • A Linder, H Toomes
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    ABSTRACT: The presently known methods of thoracoscopic surgery are a symbiosis of traditional thoracic surgery and of new endoscopic techniques. The traditional methods determine the proceeding on the organ, the innovative ones the measure to reach it. The challenge is to carry out traditional procedures on the lung by means of the new technique without loss of quality. The accomplishments of simple thoracoscopic operations on lung, pleura, and mediastinum are mostly determined. In cases of major thoracic surgical interventions new resection techniques, not yet proven on lung vessels and bronchi are increasingly undertaken. This means an innovation in two respects and is therefore difficult to evaluate. In our clinic thoracoscopic surgical techniques are orientated towards preserving the established methods on the organ via new accesses with recently developed endoscopic instruments. After having treated over 400 patients, we are now able to show that the presented thoracoscopic methods offer an advanced and safe way towards modern thoracic surgery. However, it is too early to present standardized surgical techniques of thoracoscopic surgery.
    Der Chirurg 09/1994; 65(8):657-63. · 0.52 Impact Factor
  • G Friedel, A Linder, H Toomes
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    ABSTRACT: Breast cancer is the most common malignant disease in women in Europe. In 15-25% of cases, the isolated formation of pulmonary metastases occurs. To date these metastases have been treated mainly by chemotherapy, radiotherapy, or hormone therapy. However, good results through pulmonary metastatic resection have been reported increasingly in recent times. From 1979 to 1992, 103 breast-cancer patients underwent surgery for suspected pulmonary metastases in our clinic. Intraoperatively in 88% of the whole group the metastases were confirmed, but in the other 12% they proved to be benign tumors or primary bronchial carcinomas. The operative therapy is standardized in our clinic. The approach is via a median or transverse sternotomy. Wedge resection is the normal procedure, undertaken in 55% of the cases. Complications, which were completely reversible in all cases, occurred in 3%. The 30-day mortality rate was 0%. In the whole patient population, the actuarial 5-year survival was 27%; it was 31% among the completely resected women, whereas no patient undergoing incomplete resection survived 5 years. Taking prognostic criteria into account, there are clear trends. When the disease-free interval exceeded 2 years, the actuarial 5-year survival was 33%, and if the receptor status of the primary tumor was positive, the 3-year survival was 61% compared to 38% for cases with negative receptor status. If a solitary metastasis was removed, the actuarial 5-year survival was 35% as opposed to 0% in cases with more than five metastases.(ABSTRACT TRUNCATED AT 250 WORDS)
    The Thoracic and Cardiovascular Surgeon 05/1994; 42(2):71-5. · 0.93 Impact Factor
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    ABSTRACT: Background: The aim of this study was to demonstrate the content of drug-transporting and -metabolizing enzymes in primary lung cancer. Material and Methods: We investigated 20 specimens of lobectomies, bilobectomies, pneumonectomies and extended pneumonectomies of patients suffering from lung Results: In normal bronchial tissue and various primary lung tumors, we observed a high content of glycoprotein 170 (gp 170), and glutathione S-transferase (GST) placenta (π) and liver (α) types. Gp 170 and GSTπ were localized in columnar epithelium, excretory ducts, serous glands, muscles, cartilage, nerves and vessel walls. Nine of 12 squamous cell carcinomas showed a considerable quantity of gp 170, comparable with the amount of gp 170 in the proximal tubules of the kidney. All of them stained for GST π. GST α was demonstrable to a lesser extent than GSTπ. Only few of the carcinomas stained markedly positive for GSTα. There was no correlation between the quantity in normal bronchial tissue and the corresponding tumor for any enzyme studied. Conclusions: If gp 170 and GST play a role in primary chemoresistance, expecially in multiple drug resistance, our results explain the high rate of primary chemoresistance in non-small cell lung tumors.
    Onkologie 01/1994; 17(1):28-34. · 1.00 Impact Factor
  • G Friedel, A Linder, H Toomes
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    ABSTRACT: Video-assisted and thermometrically controlled thoracoscopic sympathectomy demonstrates new ways in the treatment of upper-limb hyperhidrosis. An anatomical portrayal of the sympathetic chain is possible as a result of the improved visualization and magnification of the operative area provided by the video-optic technique. The difference in temperature, registered by means of a thermometric sensor in the palm of the hand, indicates that the sympathetic nerves responsible for the hyperhidrotic segments have been severed. The number of postoperative Horner's syndromes will be reduced significantly with this method. Until now, we have successfully treated six thermometrically controlled patients. No recurrences have arisen during an 18 months observation period. Neither intraoperative nor postoperative complications were recorded. One patient complained of increased compensatory sweating of the trunk. Thermometrically controlled thoracoscopic sympathectomy is expected to improve the various forms of treatment available for sympathetic reflex dystrophies in the future.
    The Thoracic and Cardiovascular Surgeon 09/1993; 41(4):245-8. · 0.93 Impact Factor
  • A Linder, G Friedel, H Toomes
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    ABSTRACT: In a pilot study involving six patients, palmar thermometry was used as a non-invasive method for intraoperative success control during thoracic sympathectomy. Using commercially available thermo-elements and amplifier modules, a marked increase in temperature could be registered in five patients after the severance of their rami communicants grisei for the hand. This effect was associated with the long-term success of therapy for hyperhidrosis in all five patients. This initial experience demonstrates that palmar thermometry is sensitive enough to measure surgical success intraoperatively. The limit of the thoracic sympathectomy in the cranial direction is indicated intraoperatively and Horner's syndrome is avoided with certainty.
    The Thoracic and Cardiovascular Surgeon 09/1993; 41(4):242-4. · 0.93 Impact Factor
  • A Linder, G Friedel, H Toomes
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    ABSTRACT: During the last two years video-assisted operative thoracoscopy has introduced new impetus into thoracic surgery. Today it is viewed as a sparing and safe alternative to thoracotomy for a wide spectrum of indications. The prerequisites, instruments, and operative techniques are discussed. In oncological thoracic surgery it still remains to be verified whether the criteria of radicality are fulfilled by this new technique. Using video-assisted operative thoracoscopy, we have successfully operated on 209 patients with the following indications: recurrent pneumothorax (n = 94), interstitial lung disease (n = 25), coin lesion (n = 20), pleural effusion (n = 17), hyperhidrosis (n = 14), mediastinal tumor or lymphoma (n = 10), thoracic empyema (n = 9), bullous emphysema (n = 8), pleural tumor (n = 5), hematothorax (n = 3), malignant pericardial effusion (n = 3), and chylothorax (n = 1). The advantages of this minimally traumatizing operating technique lie in a better view of the operative site, the objectively measurable reduction in postoperative restriction, less pain, earlier postoperative mobilization, and shorter hospital stay. This operating technique, in addition to being sparing, requires markedly less time than a thoracotomy. The disadvantages are the two-dimensional monitor picture and, especially, the loss of palpation.
    The Thoracic and Cardiovascular Surgeon 07/1993; 41(3):140-6. · 0.93 Impact Factor
  • A Linder, G Friedel, H Toomes
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    ABSTRACT: Video-assisted thoracoscopic surgery has markedly changed the management of recurrent pneumothorax. Thoracotomy is no longer the routine approach for the surgical treatment of bullae, partial pleurectomy, or various methods of pleurodesis. Many surgical procedures on the lung and the pleura can be performed endoscopically as safely and easily as in open thoracic surgery. These new techniques have been assessed in 94 patients. An early analysis of the postoperative data shows that the minimally invasive procedure reduces postoperative discomfort and the length of hospital stay; the rate of recurrence is no higher than that for open pneumothorax surgery.
    Endoscopic surgery and allied technologies 01/1993; 1(5-6):253-60.
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    ABSTRACT: Pulmonary affections caused by atypical mycobacteria are an increasingly common problem particularly in patients with immune deficiency disorders. We here report a case of pulmonary infiltrates due to Mycobacterium xenopi in a patient after allogeneic bone marrow transplantation for acute myeloid leukemia in first complete remission and under immunosuppressive treatment with prednisolone and Cyclosporin A. While sputum cultures, serology as well as bronchial lavage and transbronchial biopsy remained inconclusive, diagnosis could only be established by open lung biopsy. We suggest that particularly in immunocompromised patients unclear pulmonary infiltrates require rapid and possibly invasive diagnostic procedures.
    Pneumologie 06/1991; 45(5):340-2.
  • H Toomes, A Linder, G Friedel
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    ABSTRACT: An important condition for careful operations in lung surgery are modern anesthesia procedures like one-lung ventilation and high-frequency jet ventilation. The aim of careful procedures is the preservation of normal lung tissue. Most commonly broncho- and angioplastic resections are performed to avoid a pneumonectomy without loss of radicality. Minimally invasive endoscopic surgical techniques combined with laser application complete the spectrum of careful procedures in thoracic surgery, e.g., for resection of lung cysts or for thoracic sympathectomy.
    Langenbecks Archiv für Chirurgie. Supplement. Kongressband. Deutsche Gesellschaft für Chirurgie. Kongress 02/1991;
  • H Toomes, L Swoboda
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    ABSTRACT: Lung transplants have been attempted since 1963 but with little success. After fundamental work by the Toronto group with improved surgical techniques and after the introduction of cyclosporin that group was able to present convincing results. Of 16 unilaterally transplanted patients with pulmonary fibrosis in the final stage, 10 are still living, one of them for now 5 years. With bilateral lung transplantation the indication was extended to cover further pulmonary diseases in the final stage, such as emphysema, bronchiectases, eosinophilic granuloma, primary pulmonary hypertension and bronchiolitis obliterans. The unilateral lung transplantation performed by us failed after initially excellent functioning, on the 9th postoperative day because of a Pseudomonas infection that had been transferred with the donor organ.
    Pneumologie 03/1990; 44 Suppl 1:661-2.
  • L Swoboda, H Toomes
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    ABSTRACT: Between 1977 and 1988, 301 surgical interventions were performed in patients with pulmonary metastases. In 174 of these patients the procedure was considered to be potentially curative. In this group of patients, we observed a three-year survival rate of 57%, and a five-year survival rate of 38%. Among those patients who were not curatively treatable, only 7% were still alive after three years.
    Pneumologie 03/1990; 44 Suppl 1:269-70.
  • H Toomes, A Linder
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    ABSTRACT: Mucociliary clearance is an important cleaning system of the bronchial tree. The complex transport system reacts sensitively to medicinal stimuli and inhaled substances. A disturbance causes secretion retention which encourages the development of acute and chronic pulmonary diseases. It is not yet known in which way sectional resection of the central airway effects mucociliary clearance. A large number of the surgical failures are attributable to septic complications in the area of the anastomosis. In order to study the transportation process over the anastomosis, ten dogs underwent a tracheal resection with end-to-end anastomosis, and the mucociliary activity was recorded using a bronchoscopic video-technical method. Recommencement of mucous transport was observed on the third, and transport over the anastomosis from the sixth to tenth, postoperative days. The mucociliary clearance had completely recovered on the twenty-first day in the majority of dogs. Histological examination of the anastomoses nine months postoperatively showed a flat substitute epithelium without cilia-bearing cells in all dogs. This contrasts with the quick restitution of the transport function. In case of undamaged respiratory mucosa, a good adaptation of the resection margins suffices for the mucous film to slide over the anastomosis.
    The Thoracic and Cardiovascular Surgeon 11/1989; 37(5):277-80. · 0.93 Impact Factor
  • A Linder, H Toomes, L Swoboda
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    ABSTRACT: A 90-year-old patient was admitted to our clinic after two weeks of dangerously increasing hemoptysis. Bronchoscopy showed the segment bronchi of the right lower lobe to be subtotally occluded by a tumour. A biopsy was not taken because of simultaneous bleeding. After weighing the risks, surgery was decided on despite the advanced age of the patient. The centralized position of the tumour necessitated a bilobectomy. Histology showed a small-cell bronchial carcinoma T2N1M0. After initial secretion retention and mild transitional syndrome, the postoperative course was uncomplicated. Four weeks after surgery, the patient could be transferred to his local hospital where he was discharged home after a further two months. There was no reappearance of hemoptysis. At the last check-up, one year postoperatively, there was no tumour recurrence. The patient lives alone in his flat as prior to surgery. This case shows that, in individual patients, larger pulmonary resections are also possible and justified in the tenth decade of life.
    The Thoracic and Cardiovascular Surgeon 07/1989; 37(3):190-2. · 0.93 Impact Factor