H Toomes

Heinrich-Heine-Universität Düsseldorf, Düsseldorf, North Rhine-Westphalia, Germany

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Publications (81)102.64 Total impact

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    ABSTRACT: Between 1980 and 1995, 77 patients underwent complete resection of pulmonary metastases from a renal cell carcinoma after exclusion of a primary tumor recurrence and other metastatic localizations. 30-day mortality was 3%. The Median follow-up was 34 months (M). Cumulative 5-year survival (5-YS) was 39%. Prognostic criteria are the duration of the disease-free interval (DFI) and the number of metastases. Patients with a DFI > or = 48 M had a 5-YS of 46% compared to 26% for a DFI of < 48 M. Patients with a solitary metastasis had a 5-YS of 49% compared to 19% for multiple metastases. There was no significant difference in terms of sex, kind of access, kind of operation, and unilateral or bilateral affection. Since metastases from renal cell carcinomas are almost resistant to chemotherapy and radiotherapy and immunotherapy at present does not considerably improve long-term survival, surgical resection currently is the only effective therapeutic access in renal cell cancer metastasized to the lung.
    No preview · Article · Nov 1998 · Anticancer research
  • G Friedel · D Hruska · H Toomes

    No preview · Article · Sep 1998
  • G Friedel · M Hürtgen · H Toomes
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    ABSTRACT: In contrast to its use in other surgical disciplines, intraoperative sonography has so far been of minor importance in thoracic surgery. The technique of intrathoracic, intraoperative, ultrasonic examination was applied in 85 patients with different indications: in 61 patients during thoracoscopy, in 24 patients during open thoracic surgery. 6 patients eventually underwent a combination of both procedures. In order to improve the intrathoracic maneuverability of the sonographic probe we developed an electrically controllable handle for the probe. The examinations showed a high sensitivity of thoracoscopic ultrasonography for localization of intrapulmonary tumors. In addition, ultrasound was applied to assess the operability of central tumors. The sound frequency available so far for intraoperative application allows a safe distinction of non-infiltrating tumors from vascular structures; the reliable identification of an infiltration mostly requires a higher resolution. If our experiences are confirmed by further application of the method, explorative thoracotomies will surely be partly replaced by explorative thoracoscopic interventions. Ultrasonography has also proved to be useful in visualisation of mediastinal lymph-nodes and tumors, with the possibility of assessing their size.
    No preview · Article · Jul 1998 · The Thoracic and Cardiovascular Surgeon

  • No preview · Article · Jun 1998 · Onkologie
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    ABSTRACT: Lack of tumor selectivity is a severe limitation of cancer chemotherapy. Consequently, reducing dose-limiting organ toxicities such as the cardiac toxicity of doxorubicin (Dox) is of major clinical relevance. Approaches that would facilitate a more tumor-selective anticancer therapy by using nontoxic prodrugs that are converted to active anticancer agents at the tumor site have been the subject of intensive research. One potential method to overcome the cardiac toxicity of Dox is to apply a nontoxic, glucuronide prodrug (HMR 1826) from which Dox is released by the action of beta-glucuronidase, an enzyme present at high levels in many tumors. Using a recently developed, isolated, perfused human lung model, we compared the uptake of Dox into normal lung and lung tumors after a 2.5-h lung perfusion with doxorubicin (n = 8) and with the novel doxorubicin glucuronide prodrug (n = 8). Dox showed a poor uptake into lung tumors as compared with normal lung [mean Dox concentration at the end of perfusion, 1.78 +/- 3.11 (median, 0.66) microg/g versus 22.03 +/- 10.4 (median, 18.5) microg/g; P < 0.001]. However, after perfusion with HMR 1826, the level of Dox in tumor tissue was about 7-fold higher than after perfusion with Dox itself [14.04 +/- 12.9 (median, 12.9) microg/g versus 1.78 +/- 3.11 (median, 0.66) microg/g, P < 0.05, n = 8]. In vitro experiments showed a significantly higher beta-glucuronidase expression and activity in the tumors. The extent of in vitro cleavage of HMR 1826 by homogenized lung tissue was closely related to the content of beta-glucuronidase (r = 0.9834, P < 0.0001). When D-saccharolactone, a specific inhibitor of beta-glucuronidase, was added to the perfusate containing HMR 1826, no accumulation of Dox in lung tissue was seen. These data indicate that the high Dox levels achieved in the tumors with HMR 1826 resulted from cleavage of the prodrug by beta-glucuronidase at the tumor site. Thus, the problem of poor Dox uptake into lung tumors could be circumvented by applying the doxorubicin glucuronide prodrug. Several lines of evidence based on both ex vivo and in vitro results indicate that the approach described using a glucuronide prodrug may be useful in facilitating more selective delivery of chemotherapy to tumors in humans.
    Full-text · Article · Jul 1997 · Cancer Research
  • M Hürtgen · A Linder · G Friedel · H Toomes
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    ABSTRACT: This survey addressed common methods of video-assisted thoracoscopic pleurodesis for spontaneous pneumothorax. A questionnaire asking for frequency, recurrence rate and complications of the different methods of pleurodesis was sent to all hospitals that belong to the German Society for Thoracic Surgery. 19 hospitals reported on a total of 1365 operations. 88 recurrences (6.5%), 26 severe bleeding complications (1.9%), 39 persisting air leaks (2.9%) and two hospital deaths (0.1%) had been observed. Pleurectomy and pleural abrasion were the most common procedures but induced significant (p = 0.01) more bleeding complications (3.1% and 2.6%) than all other methods of pleurodesis (0.4%). Overall recurrence rates depended significantly on the chosen procedure (p = 0.0013). Pleurectomy (4.4%) and coagulation of the pleura (2.7%) showed better results than the average. Due to smaller numbers of operations and the widely differing results this significance cannot be shown for the individual recurrence rates of the different clinics. This survey demonstrated a trend towards lower rates of recurrence and complications after coagulation of the pleura parietalis. The retrospective character of the investigation and extremely different recurrence rates for different hospitals demand cautious interpretation of these results.
    No preview · Article · Feb 1997 · Zentralblatt für Chirurgie
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    ABSTRACT: Objectives: The International Registry of Lung Metastases was established in 1991 to assess the long-term results of pulmonary metastasectomy. Methods: The Registry has accrued 5206 cases of lung metastasectomy, from 18 departments of thoracic surgery in Europe (n = 13), the United States (n = 4) and Canada (n = 1). Of these patients, 4572 (88%) underwent complete surgical resection. The primary tumor was epithelial in 2260 cases, sarcoma in 2173, germ cell in 363, and melanoma in 328. The disease-free interval was 0 to 11 months in 2199 cases, 12 to 35 months in 1857, and more than 36 months in 1620. Single metastases accounted for 2383 cases and multiple lesions for 2726. Mean follow-up was 46 months. Analysis was performed by Kaplan-Meier estimates of survival, relative risks of death, and multivariate Cox model. Results: The actuarial survival after complete metastasectomy was 36% at 5 years, 26% at 10 years, and 22% at 15 years (median 35 months); the corresponding values for incomplete resection were 13% at 5 years and 7% at 10 years (median 15 months). Among complete resections, the 5-year survival was 33% for patients with a disease-free interval of 0 to 11 months and 45% for those with a disease-free interval of more than 36 months; 43% for single lesions and 27% for four or more lesions. Multivariate analysis showed a better prognosis for patients with germ cell tumors, disease-free intervals of 36 months or more, and single metastases. Conclusions: These results confirm that lung metastasectomy is a safe and potentially curative procedure. Resectability, disease-free interval, and number of metastases enabled us to design a simple system of classification valid for different tumor types. (J Thorac Cardiovasc Surg 1997;113:37-49)
    No preview · Article · Jan 1997 · The Journal of thoracic and cardiovascular surgery
  • G Friedel · H Toomes
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    ABSTRACT: Quality management in lung cancer needs interdisciplinary cooperation among thoracic surgeons, pneumologists, oncologists and radiologists. This requires defined standards in the structure, process and outcome quality of the involved departments. The German Society for Thoracic Surgery has established a concept for internal and external quality assurance of operative treatment of lung cancer, according to the requirements for quality management developed by Selbmann. The future calls for the integration of nonoperative treatments in conjuction with relevant specializations.
    No preview · Article · Jan 1997 · Langenbecks Archiv für Chirurgie. Supplement. Kongressband. Deutsche Gesellschaft für Chirurgie. Kongress
  • M Hürtgen · A Linder · G Friedel · H Toomes
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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.
    No preview · Article · Sep 1996 · The Thoracic and Cardiovascular Surgeon
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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.
    No preview · Article · Jul 1996 · The Thoracic and Cardiovascular Surgeon
  • 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.
    No preview · Article · Feb 1996 · European Surgery
  • P Froeschle · G Friedel · S Pfeiffer · H Toomes
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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.
    No preview · Article · Feb 1996 · Langenbecks Archiv für Chirurgie. Supplement. Kongressband. Deutsche Gesellschaft für Chirurgie. Kongress
  • G Friedel · A Linder · S Pfeiffer · H Toomes
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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.
    No preview · Article · Feb 1996 · Langenbecks Archiv für Chirurgie. Supplement. Kongressband. Deutsche Gesellschaft für Chirurgie. Kongress
  • G. Friedel · H. Toomes
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    ABSTRACT: Background: Quality 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. Methods: In the pilot periods of 1992 and 1993 a data pool for external QA and a basic concept for internal QA was elaborated. Results: External QA is based on a therapy-related indicator, thoracotomies and sternotomies. The application of tracer-diagnoses does not seem to be useful in thoracic surgery, since adequate therapy of rare diseases represent important quality features of specialized departments. Conclusions: On 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.
    No preview · Article · Jan 1996
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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.
    No preview · Article · Apr 1995 · Pneumologie
  • 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.
    No preview · Article · Sep 1994 · Der Chirurg
  • 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.
    No preview · Article · Sep 1994 · Der Chirurg
  • G. Friedel · A. Linder · H. Toomes
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    ABSTRACT: Recurring malignant pleural effusion is a common problem with carcinomas invading the pleural surface. Associated symptoms like dyspnoea, cough, and arrhythmia considerably limit the patient's remaining quality of life. Numerous methods have been advocated to induce pleurodesis. The various forms of treatment range from chest tube drainage over instillations of sclerosing substances like tetracyclines, cytostatics, and talc to pleurectomy. None of these treatments, however, so far fulfills the demands for maximum effectiveness with a low rate of recurrence and morbidity. With the introduction of video-assisted thoracoscopic pleurectomy, a method with a low rate of recurrence and morbidity is now at our disposal. During the last 18 months 21 patients with various primary tumours have undergone pleurectomy for pleural carcinomatosis in our hospital. All patients had previously been treated by other methods. In all cases of secondary pleural carcinomatosis a complete parietal pleurectomy was possible. The intra-operative loss of blood was low, with an average of 370 ml. Intra- or post-operative complications did not occur. The mean duration of chest tube drainage was 7 d and the post-operative hospital stay 12 d. During a period of 18 months we have recorded one recurrence requiring no further treatment. These results show that video-assisted thoracoscopic pleurectomy should be undertaken early when other non-invasive methods have failed.
    No preview · Article · Jun 1994 · Minimally Invasive Therapy
  • 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)
    No preview · Article · May 1994 · The Thoracic and Cardiovascular Surgeon
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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.
    No preview · Article · Jan 1994 · Onkologie

Publication Stats

1k Citations
102.64 Total Impact Points

Institutions

  • 2005
    • Heinrich-Heine-Universität Düsseldorf
      Düsseldorf, North Rhine-Westphalia, Germany