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Biomedical subjects

T E Acuff

Publications and source records attributed to T E Acuff.

31 records · Page 2Linked to original sources
PubMed1993

Application of thoracoscopy for diseases of the spine.

For anterior approaches to the thoracic spine, a posterolateral thoracotomy has been the standard approach. Recent expanded experience with video-assisted thoracic surgical techniques has allowed us to perform many thoracic spine procedures that previously required open approaches. These procedures include drainage of spinal abscesses, biopsy of vertebral bodies, discectomy for a herniated nucleus pulposus, and anterior releases for kyphoscoliosis. All procedures were successful, but experience is limited and follow-up still short. It is hoped that further experience will prove that this less invasive approach can be widely applied in the practice of thoracic spinal surgery.

Humans↗
PubMed1993

Implantable cardioverter defibrillator: the role of thoracoscopy.

Video techniques have been used in many centers to assist with pericardial patch placement for implantable defibrillators. Although there are some specific instances where this technique would be helpful, the success of the transvenous systems will limit the application of this approach.

Defibrillators, Implantable↗
PubMed1993

Role of mechanical stapling devices in thoracoscopic pulmonary resection.

For its first 80 years, thoracoscopy was primarily reserved for the evaluation and treatment of pleural disease. Extension of thoracoscopic techniques to management of parenchymal lung disease remained limited until the availability of endostaplers and adaption of video-assisted techniques through minimal access incisions. The widespread acceptance of mechanical staplers in open lung resections during the previous two decades has facilitated conversion to closed methods in the past 2 years. A variety of techniques for mechanical stapling in thoracoscopy are discussed. The impact of mechanical stapling in 300 consecutive thoracoscopic pulmonary resections is presented.

Humans↗
PubMed1993

Thoracoscopic pericardiectomy for effusive pericardial disease.

Thoracoscopic techniques were used to perform a pericardiectomy in 35 patients with purely effusive pericardial disease after medical management and pericardiocentesis had failed to be effective. There were no intraoperative complications and postoperative complications were few. Two cases of dysrhythmia and 2 cases of pneumonia occurred postoperatively. Malignancy was identified as the cause in 18 patients and there were benign causes in the remaining 17. The hospital stay in the group with benign effusions was 4.6 days. There were no recurrences of pericardial effusions and no constrictive changes developed during a mean follow-up of 9 months. Fourteen (40%) patients had pleural or pulmonary abnormalities that were managed simultaneously thoracoscopically. These abnormalities included 2 pleural masses, 2 pulmonary nodules, and 12 pleural effusions. In 8 instances, the pericardiectomy was performed from the right pleural cavity in order to address the pleural or pulmonary problem. Thoracoscopic pericardial resection has proved safe and effective. It allows a wider pericardial resection than that usually permitted by the subxiphoid route, and should lessen the pain and the number of pulmonary complications, compared with open thoracotomy. An additional advantage is that it allows the visualization and management of simultaneous pleural and pulmonary abnormalities.

Follow-Up Studies↗
PubMed1993

Video thoracoscopic management of benign and malignant pericardial effusions.

Surgical management of symptomatic benign and malignant effusive pericarditis is often required. Twenty-two patients with medically recalcitrant effusive, nonconstrictive pericarditis underwent pericardial resection by a video-assisted thoracoscopic surgical (VATS) technique (9 malignant, 13 benign). Pericardiectomy, resulting in complete drainage of the pericardial space and control of patient symptoms was accomplished routinely. Ipsilateral pleural effusions, originally present in 11 patients, were also managed. The VATS pericardiectomy was well tolerated even by gravely ill patients. This approach should be considered as an alternative to lateral thoracotomy or subxiphoid pericardial window for the surgical management of patients with symptomatic benign and malignant pericardial effusions.

Humans↗
PubMed1993

Thoracoscopic mediastinal lymph node sampling: useful for mediastinal lymph node stations inaccessible by cervical mediastinoscopy.

Cervical mediastinoscopy is useful for the diagnosis of paratracheal lymph node metastasis from bronchogenic carcinoma. Access to adenopathy in the aorticopulmonary window, anterior mediastinal, periazygos, and subcarinal lymph nodes is difficult with this technique. Operative visibility in these locations through anterior mediastinotomy, the Chamberlain procedure, is limited. We have used thoracoscopic mediastinal exploration in 40 patients with computed tomographic scan evidence of enlarged aorticopulmonary window (n = 30) or enlarged right periazygos or subcarinal lymph nodes (n = 10). This procedure was used primarily as an adjunct to cervical mediastinoscopy in the staging of bronchogenic carcinoma. Adjunctive thoracoscopic nodal sampling was 100% sensitive and 100% specific in diagnosing the mediastinal adenopathy. It did not significantly delay thoracotomy in cases of benign adenopathy. Visibility of the ipsilateral pleural space and mediastinum was excellent. Thoracoscopic exploration with mediastinal nodal sampling is a valuable diagnostic adjunct for assessment of adenopathy inaccessible to cervical mediastinoscopy and can overcome many of the limitations of anterior mediastinotomy.

Adult↗
PubMed1992

Percutaneous localization of pulmonary nodules for thoracoscopic lung resection.

A limiting factor in removing pulmonary nodules by videothoracoscopic techniques is the inability to locate lesions deep within the substance of the lung. We describe a technique in which a hook wire commonly used to localize nonpalpable breast lesions is placed percutaneously into the lung nodule preoperatively. Using the wire anchored into the lung as a guide, the target lesion can be successfully identified and removed thoracoscopically.

Humans↗
PubMed1992

Present role of thoracoscopy in the diagnosis and treatment of diseases of the chest.

Since thoracoscopy was originally described in 1910, the application has been limited mainly to the diagnosis and treatment of pleural disease. Recent advancements in endoscopic equipment and refinement of surgical techniques have expanded the application of this procedure. Using video thoracoscopic techniques in 70 patients over the past 9 months, we have been able to perform a variety of procedures previously accomplished by "open" techniques. These procedures include (1) wedge resections of pulmonary nodules in 21 patients, using endoscopic mechanical stapling devices; (2) excision of the pericardium and drainage of the pericardial space in 6 patients; (3) dorsal thoracic sympathectomy in 6 patients; (4) apical blebectomy and pleurodesis in 6 patients; (5) lung biopsies for diagnosis of diffuse lung disease in 5 patients. Additional procedures performed include biopsy of hilar masses (3), biopsy of esophageal mass, excision of a mediastinal cyst, and the drainage of a spinal abscess. The remaining 20 procedures were performed for the diagnosis and treatment of pleural disease. There was no mortality associated with the procedure and morbidity was lessened, compared with standard thoracotomy procedures. The postoperative hospital stay after elective procedures performed in well patients averaged 3 days and was often as short as 1 day. Our experience indicates a markedly expanded role for thoracoscopy in the diagnosis and treatment of thoracic diseases with less postoperative morbidity.

Adult↗
PubMed1992

Video-assisted thoracic surgery: basic technical concepts and intercostal approach strategies.

Video-assisted thoracic surgery is emerging as a viable approach to a number of intrathoracic disorders. Technical difficulties related to improper instrument selection and suboptimal intercostal operative access can reduce the utility of, and the enthusiasm for, the video-assisted thoracic surgical approach. This report describes the intercostal access strategy and the instrument positioning that we now prescribe for many video-assisted thoracic surgical procedures. These approaches have become refined during the course of our experience with 467 patients undergoing video-assisted thoracic operations over the last 18 months.

Endoscopes↗
PubMed1983

Intracerebroventricular captopril does not inhibit osmotically stimulated vasopressin release.

Experiments were carried out to determine the effect of intracerebroventricular (icv) administration of the angiotensin-converting enzyme inhibitor, captopril, on osmotically stimulated vasopressin secretion. During icv infusion of captopril (3.1 micrograms/kg . min), dogs were infused intravenously (iv) with either 2.5 or 0.15 M NaCl. Control groups received an osmotically equivalent mannitol solution icv with the 2.5 or 0.15 M NaCl iv infusion. As a result of the iv hypertonic saline infusion, plasma vasopressin concentrations increased progressively and in concert with the plasma osmolality; this response was not altered by icv captopril. Plasma vasopressin levels were unchanged during iv isotonic saline infusion, and, again, icv captopril was without effect. At the completion of the icv infusions, injection of angiotensin I icv (310 ng/kg) produced a markedly greater increase in plasma vasopressin levels in animals which had received mannitol icv, compared to those which had received captopril icv. On the basis of these findings, a role for an intrinsic brain renin-angiotensin system, if such a system exists, in the osmotic control of vasopressin secretion is seriously questioned, but not ruled out.

Animals↗
PubMedDate not supplied

Bacterial contamination of enteral nutrient solution: a preliminary report.

The technique of continuous pump/tube enteric feeding is being utilized with ever increasing frequency and success. Commercially available formulas are being repackaged in 1-liter plastic containers for ease in clinical use. The nutrient solution often hangs at the patient's bedside at room temperature for periods of 8 to 12 hrs and the possibility of significant and serious bacterial growth must be recognized as a potential problem. Though this has never appeared to be a clinical problem in over 15,000 pump/tube feeding days, the bacteriology has not been previously studied. This preliminary study suggests that the major source of nutrient solution contamination relates to the technique of transfer from the commercial can to the clinical liter plastic container and that "hang" times of 8 to 12 hrs at room temperature are quite reasonable if appropriate care is exercised in the transfer process.

Bacteria↗
PubMedDate not supplied

Cardiac applications of video assisted thoracic surgery.

As experience with video assisted thoracic surgery (VATS) has grown, cardiac applications of VATS are being explored. Simple cardiac procedures including pericardiectomy and epicardial pacemaker lead placement are readily accomplished by VATS. More complex cardiac procedures are being investigated both in the laboratory and in the clinical arena. Totally endoscopic coronary artery bypass grafting has been successfully performed in the animal model. Modification of existing instrumentation and techniques has had an enabling benefit. The human experience consists of predominantly a video assisted minithoracotomy approach with some successful promise. More advanced procedures including minimally invasive valve replacement are also being explored.

Animals↗