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Biomedical subjects

T M Daniel

Publications and source records attributed to T M Daniel.

At least 19 recordsLinked to original sources
PubMed1995

Stroke rate is markedly reduced after carotid endarterectomy by avoidance of protamine.

PURPOSE: Postoperative neurologic injury remains a significant risk of carotid endarterectomy. Mechanisms include embolization of debris and formation of thrombus on the newly endarterectomized surface. We hypothesized that the risk of postoperative neurologic injury would be lower in those patients who did not receive protamine for reversal of heparin anticoagulation. METHODS: We reviewed 348 consecutive primary carotid endarterectomies performed since January 1, 1986, to determine the relationship between surgical outcomes and reversal of heparin anticoagulation. Patients undergoing additional simultaneous cardiovascular procedures were excluded. One hundred ninety-three patients received protamine after completion of the endarterectomy. The remaining 155 patients did not receive any protamine. RESULTS: All patients in both groups survived to discharge. There were no strokes in those patients who did not receive any protamine; however, the stroke rate in the protamine group was 2.6% (5 of 193), p < 0.045. The incidence of hematoma requiring reexploration was 1.0% (2 of 193) and 1.9% (3 of 155) in the protamine and no-protamine groups, respectively (p = NS). Intraoperative shunting was used more frequently in the no-protamine group (84% vs 67%, p < 0.001), and patch angioplasty was performed more frequently in the protamine group (35% vs 15%, p < 0.001). However, neither shunting nor patching significantly influenced stroke rates. CONCLUSIONS: We conclude that carotid endarterectomy without reversal of heparin anticoagulation is associated with a reduced postoperative stroke rate without a significant increase in morbidity rates.

Aged↗
PubMed1995

Anterior lung herniation: another aspect of the seatbelt syndrome.

Shoulder harnesses can be a source of thoracic injury in motor vehicle crashes. Sternal and rib fractures are most commonly reported. We present a case of a traumatic anterior lung herniation secondary to shoulder harness trauma in a motor vehicle crash victim with multiple injuries. A brief review of lung hernias is provided as well as a brief discussion of the thoracic manifestations of the seatbelt syndrome.

Accidents, Traffic↗
PubMed1995

Chemoprophylaxis of multidrug-resistant tuberculous infection in HIV-uninfected individuals using ciprofloxacin and pyrazinamide. A decision analysis.

STUDY OBJECTIVE: To evaluate the use of ciprofloxacin and pyrazinamide for the prophylaxis of individuals infected with multiply drug-resistant strains of Mycobacterium tuberculosis. DESIGN: Decision analysis, using software (SMLTREE). Probabilities based on published studies, with sensitivity analysis for each probability. SETTING: Health-care workers infected with multidrug-resistant strains of M tuberculosis. INTERVENTIONS: Prophylaxis with ciprofloxacin and pyrazinamide. MEASUREMENTS AND RESULTS: We calculated the utilities of taking or not taking prophylaxis with ciprofloxacin and pyrazinamide. The decision analysis favored the use of ciprofloxacin-pyrazinamide prophylaxis by a small margin. CONCLUSION: Ciprofloxacin-pyrazinamide prophylaxis should be considered for health-care workers infected with multiply drug-resistant M tuberculosis.

Adult↗
PubMed1994

Use of video-assisted thoracic surgery in the treatment of chylothorax.

Chylothorax, a potentially lethal disorder that may cause profound respiratory, nutritional, and immunologic complications, has become increasingly common in recent years. Medical therapy has been found to have a significant failure rate. Therefore, surgical treatment of complicated chylothorax has become a mainstay of care. Between 1987 and 1993, ten patients at the University of Virginia Hospital were treated with video-assisted thoracic surgery for complicated chylothorax. Twelve thoracoscopic procedures were performed. Patients ranged in age from 7 months to 82 years. Causes included iatrogenic (2), congenital (2), caval thrombosis (2), amyloid (2), blunt trauma (1), and metastatic carcinoid tumor (1). In 10 cases, video-assisted thoracic surgery was employed as the principal mode of therapy: 8 using talc pleurodesis alone, 1 using talc pleurodesis and clipping of the thoracic duct with application of fibrin glue, and 1 requiring clipping of a pleural defect with application of fibrin glue. In 2 cases, a video-assisted thoracic operation was used in conjunction with pleuroperitoneal shunting: a previously placed pleuroperitoneal shunt that was malfunctioning was repositioned thoracoscopically after a pleural adhesiolysis, and a pleural adhesiolysis was performed thoracoscopically before placement of a pleuroperitoneal shunt. In all cases the effusion resolved after the video-assisted thoracic operation without further intervention. Video-assisted thoracic surgery offers an effective means of treating chylothorax, regardless of cause, allowing the advantage of access to thoracic structures without the morbidity of more extensive procedures.

Adult↗
PubMed1994

Clinical evaluation of the diagnostic value of measuring IgG antibody to 3 mycobacterial antigen preparations in the capillary blood of children with tuberculosis and control subjects.

SETTING: Department of Paediatrics in a University Hospital. OBJECTIVE: To evaluate ABC-ELISA as serodiagnostic tests for tuberculosis in children. DESIGN: An avidin-biotin-peroxidase conjugated anti-human immunoglobulin (ABC) enzyme-linked immunosorbent assay (ELISA) was established to measure serum immunoglobulin G (IgG) antibodies to polymerized old tuberculin (OT), tuberculin purified protein derivative (PPD) and the 30,000 dalton (30 kDa) native antigen of Mycobacterium tuberculosis, in 122 tuberculosis patients and 187 healthy children. RESULTS: In those patients who had received less than 3 months of chemotherapy the sensitivities of the tests based on OT, PPD and the 30 kDa antigen were 40.3%, 50.0% and 36.1% respectively; the positive predictive values were 92.6%, 94.7% and 93.8% respectively and the negative predictive values were 58.6%, 62.9% and 57.2% respectively. CONCLUSION: The ABC-ELISA may be useful for the diagnosis of pulmonary and extrapulmonary tuberculosis in groups of children with a high prior probability of tuberculosis. Antibodies to the 30 kDa antigen persisted longer than did those to OT and PPD.

Age Factors↗
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↗