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Biomedical subjects

Todd L Demmy

Publications and source records attributed to Todd L Demmy.

8 recordsLinked to original sources
PubMed2006

Minimally invasive pneumonectomy.

Technical advances have resulted in the growing popularity and success of video-assisted thoracoscopic lobectomy for the treatment of nonsmall cell lung cancer. Several investigators have used similar techniques to safely perform pneumonectomies. Minimally invasive pneumonectomy may be indicated for patients who have centrally located malignant lesions and who are not candidates for sleeve resections. Adequate exposure of the proximal hilar vessels is mandatory. Short-term results are encouraging, but prospective long-term data are essential.

Carcinoma, Bronchogenic↗
PubMed2005

Troubleshooting video-assisted thoracic surgery lobectomy.

PURPOSE: Surgeons converting their open lobectomy skills to video-assisted thoracic surgery (VATS) techniques have sought traditional technical courses, publications, and physician mentoring. While these are useful in teaching basic principles, it is more difficult to promulgate the numerous advanced techniques or technical "tricks" that deal with anatomical variations or pathologic changes in the lung tissue. DESCRIPTION: Engineers have simplified the process of rolling out complex technology by using troubleshooting guides. Accordingly, helpful video-assisted lobectomy maneuvers have been categorized according to the specific problems occasionally encountered at different points in the operation. EVALUATION: These maneuvers were compiled and reviewed by a panel of thoracic surgeons experienced in video-assisted lobectomies and have been active in teaching and mentoring of thoracic surgeons, residents and fellows. The techniques described have been used successfully by the authors to overcome exposure and instrumentation limitations, to achieve the outcomes reported in their series, and to guide trainees. CONCLUSIONS: Troubleshooting guides offer an organized means for surgeons to improve the parts of the video-assisted lobectomy procedure that they find tedious or challenging.

Humans↗
PubMed2004

Discharge independence with minimally invasive lobectomy.

BACKGROUND: The effects of video-assisted thoracic surgery (VATS) pulmonary lobectomy on after-hospital care are not well known. METHODS: In a retrospective case-control study, 20 consecutive VATS cases were matched to 38 standard thoracotomies (open cases). RESULTS: Ages were 73.8 +/- 7.8 years with no initial differences between the groups. No hospital deaths occurred. Excluding 2 VATS and 6 open outliers, VATS cases had fewer hospital days (4.6 +/- 1.9 vs. 6.4 +/- 2.2, P <0.01), chest tube days (3.0 +/- 1.1 vs. 4.2 +/- 1.7, P = 0.01), and prolonged pain complaints (28% vs. 56%, P = 0.05). Transfer to care facilities or home nursing support was needed for 63% of open patients and only 20% of VATS patients (P = 0.015). Less personal care (10% vs. 21%), wound/medical care (0% vs. 13%), occupational/physical therapy (5% vs. 13%), or other home support (5% vs. 18%) was needed for VATS patients. CONCLUSIONS: In older populations, more independence and fewer resources after discharge favor VATS lobectomy over standard thoracotomy.

Aged↗
PubMed2002

Physicians' perceptions of institutional and leadership factors influencing their job satisfaction at one academic medical center.

PURPOSE: Academic physicians' perceptions about their institution's function and leadership should provide insights toward improving faculty recruitment and retention. METHOD: The authors surveyed 105 non-management and non-emeritus physicians who had been hired by (57%) or left (43%) the University of Missouri-Columbia School of Medicine (MUHC) in 1991-1998. The questionnaire measured both the importance and the availability of 14 institutional and leadership factors and the physicians' perceptions of satisfaction with their careers. Open-ended questions assessed additional concerns. RESULTS: In all, 56% of the overall satisfaction scores were unfavorable and, when grouped by faculty department, correlated inversely with departure rates (p =.04). Scores were surprisingly similar between those who left and those who remained at the institution. "Protected time for research or personal use" was the highest faculty priority regardless of level of overall satisfaction. "Equitable distribution of salary/resources" (p =.007) and "trust-communication with chair/division head" (p =.003) predicted good satisfaction independently. Openended responses for remaining at the university related to the pleasant local community (49%), intellectual issues (46%), and humanitarian issues (5%). Responses for considering opportunities elsewhere were administrative frustration (59%), income enhancement (18%), career advancement (9%), academic frustration (9%), and other (5%). Recommendations for enhancing recruitment and retention were fix administrative concerns (45%); improve research (20%), income (9%), physician support (9%), clinical programs (8%), and autonomy (5%); and other (4%). CONCLUSIONS: Surveying physicians who were recently hired or who have left an institution provides useful information to promote organizational changes that could improve physician retention.

Attitude of Health Personnel↗
PubMedDate not supplied

Isolated lung chemotherapeutic infusions for treatment of pulmonary metastases: a pilot study.

A pilot study was designed to determine the feasibility of combining minimally invasive surgery techniques and cardiac surgical catheter technology to deliver high-dose unilateral pulmonary chemotherapy. Single lung ventilation general anesthesia was combined with catheter-based left pulmonary artery (PA) control in 4 mongrel dogs. p-Aminohippuric acid (PAH) was used to quantify leakage of pulmonary arterial infusate. Surgical exposure was progressively less invasive. Dissection of cranial and caudal pulmonary veins followed methods used in minimally invasive pulmonary lobectomy. All animals survived the experimental procedure. The Heart-Port Endoplege catheter controlled the canine PA. A volume (50 cm(3)) of infusate much smaller than the calculated pulmonary vascular volume caused less vascular overdistention and diffused throughout the pulmonary vascular bed within 3-5 min as verified by fluoroscopy. 75% of the tracer remained in the lung at the completion of the 30-min dwell time. The pulmonary circulation can be isolated by minimally invasive operative and catheter technology so that the pulmonary parenchyma can be exposed to a high concentration of a compound for at least 30 min in the canine model.

Animals↗