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Biomedical subjects

T M Daniel

Publications and source records attributed to T M Daniel.

At least 55 records · Page 3Linked to original sources
PubMed1993

Thoracoscopic surgery for diseases of the lung and pleura. Effectiveness, changing indications, and limitations.

OBJECTIVE: This study compared the results of video-assisted thoracic surgery (VATS) with thoracoscopic surgery (TS) for diseases of the lung and pleura. SUMMARY BACKGROUND DATA: No studies exist that compare the capabilities of VATS with advanced video systems and instrumentation to that of TS which has been done for 80 years. METHODS: A retrospective study was done comparing the effectiveness, indications, complications, and limitations of TS and VATS done for four categories of pleural disease: 1) pleural fluid problems, 2) diffuse lung disease, 3) lung masses, and 4) pneumothorax. The TS period was 1981-1990. The VATS period was 1991-1992. RESULTS: Eighty-nine consecutive TS cases and 64 consecutive VATS cases were reviewed. TS for resolution of pleural fluid problem was successful in 29 of 34 patients (85%), and VATS was successful in 18 of 20 (90%). Diffuse lung disease was diagnosed by TS using a cup biopsy on end-stage patients in respiratory failure. Since 1991 the diagnosis has been made with VATS using stapled wedge excisions on ambulatory patients. Surgical mortality decreased from 33% (10 of 30) to 9% (1 of 11) and the postoperative stay from 16.6 +/- 2.4 days to 8.2 +/- 2.2 days. Lung masses were diagnosed entirely by incisional biopsies using TS. Diagnosis was made in 83% and postoperative stay was 5.3 +/- 1.0 day. VATS allowed excisional biopsies permitting diagnosis in 100% with a postoperative stay of 3.0 +/- 0.2 days (p = 0.05). However, 20% required conversion to thoracotomy to locate the subpleural mass. TS was performed for spontaneous pneumothorax in only 26% (5 of 19) of the total pneumothorax cases, whereas, VATS was used for spontaneous pneumothorax in 67% (12 of 18). CONCLUSION: VATS has continued the effectiveness of TS for treating pleural fluid problems, has resulted in earlier surgical diagnostic intervention in diffuse lung disease and earlier therapeutic intervention in primary pneumothorax states, and has markedly expanded the safety, efficacy and indications for lung mass biopsy.

Adolescent↗
PubMed1993

Balloon angioplasty above the aortic arch: immediate and long-term results.

OBJECTIVE: Angioplasty above the level of the aortic arch is becoming more common, and the indications for it are increasing. We report our experience with this procedure, including life-table analysis of the long-term results. MATERIALS AND METHODS: We dilated 32 lesions in 29 patients. Early in our series, patients were referred primarily because of arm claudication or vertebrobasilar insufficiency. Subsequently, the indications were expanded to include inflow to left internal mammary-coronary artery bypass grafts, inflow to axillobifemoral bypass grafts, and inflow to dialysis fistulas in the upper extremity. A femoral artery approach was used in 18 patients and an axillary approach was used in 11. Clinical follow-up included evaluation of symptoms and bilateral measurements of peripheral pulses and blood pressure. Follow-up angiograms were obtained in nine patients. RESULTS: Eighteen of the lesions dilated were located in the left subclavian artery, eight were in the right subclavian artery, four were in the axillary or proximal brachial artery, and two were in the innominate artery. Interestingly, three of eight right subclavian arteries treated had an anomalous origin from the arch of the aorta. Initial technical success was 100%. All 29 patients had long-term follow-up of 4-88 months (mean, 36 months). In one patient, stenosis recurred 8 months after angioplasty. This patient subsequently had redilatation. Life-table analysis projected a 7.5-year cumulative primary patency rate of 96.6%. No cerebrovascular complications or embolic events occurred. CONCLUSION: Angioplasty of the great vessels is safe and effective, and the long-term results are favorable when compared with results after surgery. As a result, the indications for this procedure should be broadened.

Adult↗
PubMed1992

Transhiatal esophagectomy: a safe alternative for selected patients.

One hundred one consecutive patients underwent an esophagectomy with gastric interposition for benign and malignant processes from January 1982 through July 1990. Seventy-seven underwent transhiatal esophagectomy and 24, transthoracic esophagectomy. Multivariate analysis was performed comparing the hospitalization experience of the two groups. There was no significant difference found between the mean intraoperative blood loss for transhiatal esophagectomy (770 +/- 105 mL) and that of transthoracic esophagectomy (700 +/- 175 mL). There was a significant difference between operative time, with transhiatal esophagectomy averaging 5.4 hours and transthoracic esophagectomy averaging 7.3 hours. Postoperative stay was not significantly different although there was a wide range of values for the transthoracic esophagectomy group. An 8% operative mortality was experienced by both groups. There were a significant number of minor anastomotic leaks at the cervical anastomotic level for the transhiatal esophagectomy group, but all responded to nonoperative management. The highest morbidity and mortality were seen in the subgroup of transhiatal esophagectomies done for laryngocervical malignancies. The lowest morbidity and mortality were seen in the subgroup of 12 patients who underwent transhiatal esophagectomy for nonmalignant esophageal conditions. Transhiatal esophagectomy appears to be a safe alternative for early intrathoracic esophageal malignancies at any level, for bulky distal esophageal lesions, and for benign conditions requiring total esophagectomy.

Blood Loss, Surgical↗
PubMed1992

Microplate and dot immunoassays for the serodiagnosis of tuberculosis.

A simple dot enzyme immunoassay based on the recognition of serum IgG antibody to a 30,000 dalton native antigen purified from culture filtrates of Mycobacterium tuberculosis was developed and compared with a standard plate enzyme-linked immunosorbent assay in the serodiagnosis of tuberculosis. The previously described favorable test characteristics of plate enzyme-linked immunoassay were confirmed; although the dot enzyme immunoassay was promising, it was less satisfactory. Dot enzyme immunoassay may have its most promising use as a screening test for situations of limited technical facilities. Both plate enzyme-linked immunoassay and dot enzyme immunoassay had markedly reduced sensitivities in persons with human immunodeficiency virus infection.

Antigens, Bacterial↗
PubMed1992

Absence of Mycobacterium avium complex disease in patients with AIDS in Uganda.

The absence of disease due to Mycobacterium avium in Ugandan patients with AIDS, which we previously observed in a blood culture study, has been confirmed and our observations have been extended to 165 additional clinical isolates. Fourteen soil and water samples from the Ugandan environment have been cultured and revealed a high frequency of isolation of M. avium. The absence of M. avium complex disease in Uganda remains unexplained.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Human immune response to Mycobacterium tuberculosis antigens.

Little is known about the immunodominant or protective antigens of Mycobacterium tuberculosis in humans. Cell-mediated immunity is necessary for protection, and healthy tuberculin-positive individuals are relatively resistant to exogenous reinfection. We compared the targets of the cell-mediated immune response in healthy tuberculin-positive individuals to those of tuberculosis patients and tuberculin-negative persons. By using T-cell Western blotting (immunoblotting) of nitrocellulose-bound M. tuberculosis culture filtrate, peaks of T-cell blastogenic activity were identified in the healthy tuberculin reactors at 30, 37, 44, 57, 64, 71 and 88 kDa. Three of these fractions (30, 64, and 71 kDa) coincided with previously characterized proteins: antigen 6/alpha antigen, HSP60, and HSP70, respectively. The blastogenic responses to purified M. tuberculosis antigen 6/alpha antigen and BCG HSP60 were assessed. When cultured with purified antigen 6/alpha antigen, lymphocytes of healthy tuberculin reactors demonstrated greater [3H]thymidine incorporation than either healthy tuberculin-negative controls or tuberculous patients (8,113 +/- 1,939 delta cpm versus 645 +/- 425 delta cpm and 1,019 +/- 710 delta cpm, respectively; P less than 0.01). Healthy reactors also responded to HSP60, although to a lesser degree than antigen 6/alpha antigen (4,276 +/- 1,095 delta cpm; P less than 0.05). Partially purified HSP70 bound to nitrocellulose paper elicited a significant lymphocyte blastogenic response in two of six of the tuberculous patients but in none of the eight healthy tuberculin reactors. Lymphocytes of none of five tuberculin-negative controls responded to recombinant antigens at 14 or 19 kDa or to HSP70. Antibody reactivity generally was inversely correlated with blastogenic response: tuberculous sera had high titer antibody to M. tuberculosis culture filtrate in a range from 35 to 180 kDa. This is the first systematic evaluation of the human response to a panel of native and recombinant antigens in healthy tuberculin reactors and tuberculous patients. Antigens which stimulated prominent lymphocyte blastogenic responses were identified in seven fractions on T-cell Western blot analysis. Two of these may represent previously characterized proteins; the others may contain immunodominant proteins that will require further characterization.

Antibodies, Bacterial↗
PubMed1991

The influence of human immunodeficiency virus infection on tuberculosis in Kampala, Uganda.

The clinical, radiographic, and microbiologic features of 59 patients with pulmonary tuberculosis in Kampala, Uganda were studied and correlated with the serologic reactivity to the human immunodeficiency virus (HIV) of these patients. Two-thirds of the patients with tuberculosis were HIV-seropositive. Histories of fever and weight loss were more prominent in HIV-seropositive patients, and perihilar and basilar infiltrative diseases were more frequently seen in HIV-seropositive patients. Although all patients responded similarly to drug therapy, cutaneous drug reactions were seen in nearly one-third of HIV-seropositive patients receiving thiacetazone.

Adolescent↗
PubMed1991

Evaluation of the potential role of serodiagnosis of tuberculosis in a clinic in Bolivia by decision analysis.

Decision analysis was used to examine the potential effect on cost and expected quality of care of the introduction of serodiagnosis by enzyme-linked immunosorbent assay (ELISA) of tuberculosis at the Instituto de Torax in La Paz, Bolivia. Previously published data collected at that facility were used as the basis for this analysis. Decision trees were constructed including test availability, test result, test predictive values, and the consequences of correct or incorrect treatment decisions. Five diagnostic algorithms were assessed. ELISA was found to make a contribution to the diagnosis of tuberculosis similar to that of sputum smear. Chest roentgenography improved the quality of patient care, but it did so at substantially increased cost. While ELISA did not add to the diagnosis when sputum smear was available, it might be of great use where sputum smear is not available.

Decision Support Techniques↗
PubMed1991

Purification and characterization of the 30,000 dalton native antigen of Mycobacterium tuberculosis and characterization of six monoclonal antibodies reactive with a major epitope of this antigen.

The 30,000 dalton native antigen of Mycobacterium tuberculosis is a major constituent of this organism and is secreted into culture medium. We purified this antigen by ammonium sulfate precipitation, ion-exchange chromatography, and reverse-phase high-performance liquid chromatography to yield a single 29 to 30 kd component. The first 20 N-terminal amino acid sequence was determined and found to be identical to that reported for M. bovis alpha-antigen. Immunoelectrophoresis studies demonstrated the purified 30,000 dalton antigen to be immunologically identical with antigen 6 and antigen 85B. The 30,000 dalton native antigen was a potent skin test antigen in sensitized guinea pigs. Six immunoglobulin G1 murine monoclonal antibodies against the 30,000 dalton antigen were generated. By enzyme-linked immunosorbent assay and western immunoblotting, all six monoclonal antibodies reacted with the 30,000 dalton antigen, perhaps with the same epitope. When used with culture filtrates of other mycobacteria, the monoclonal antibodies demonstrated reactivity with M. gordonae and M. kansasii and to a lesser extent with M. avium and M. scrofulaceum.

Amino Acid Sequence↗
PubMed1991

The influence of preoperative radiation therapy on morbidity and mortality for transhiatal esophagectomy.

To assess the morbidity and mortality of preoperative radiation therapy (RT), the authors reviewed 37 consecutive patients who underwent transhiatal esophagectomy for carcinoma of the esophagus. Twelve patients received no RT, 13 patients received RT only to the neck, and 12 received RT to the chest (three of these received radiation therapy to the chest and neck). Preoperative chest RT did not significantly increase postoperative fistula formation but was associated with significantly higher operative mortality, overall complication rate, and time on ventilators than either the patients receiving neck RT alone or no RT (P less than 0.05). Postoperative hospital stay was longer and intraoperative blood loss greater for the chest RT group compared to those with no RT (P less than 0.05). Neck RT did not result in these complications (P = NS). The authors conclude that preoperative chest RT is associated with significant postoperative morbidity and mortality.

Adult↗
PubMed1991

First single lung transplant in Virginia.

Lung transplantation is now established as a clinical reality for patients with irreversible, lethal pulmonary conditions. We report the first successful application of this treatment modality in Virginia.

Humans↗
PubMed1990

Four years' experience with fibrin sealant in thoracic and cardiovascular surgery.

A single-donor fibrin sealant system was used in 689 thoracic and cardiovascular surgical procedures over the 4-year period between April 1, 1985, and March 31, 1989. An excellent overall success rate (646/689, 94% effective) was achieved with specific applications, including reduction of leakage of air (29/33, 88% effective), blood (595/634, 94% effective), and fluid (14/14, 100% effective), as well as positioning of anatomical structures such as coronary bypass grafts (8/8, 100% effective). Application methods included use of spray bottles (477/497, 96% effective), syringes (165/186, 89% effective), and a Silastic cannula through the flexible fiber-optic bronchoscope (4/6, 67% effective). The system was used in a wide variety of cardiac, pulmonary, esophageal, and vascular procedures to seal staple lines, suture lines, anastomoses, conduits, fistulas, and raw surfaces. No complications with this single-donor system secondary to blood-borne disease have been documented. Overall infection occurred at a nominal rate (16/689, 2%). Thus, fibrin sealant has been a useful tool to control the leakage of air, blood, and fluid during a wide variety of thoracic and cardiovascular procedures and may be of benefit to other surgeons.

Aerosols↗