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Biomedical subjects

W H Coltharp

Publications and source records attributed to W H Coltharp.

7 recordsLinked to original sources
PubMed1992

Videothoracoscopy: improved technique and expanded indications.

Current videoendoscopic technology and percutaneous techniques of exposure and dissection have been successfully applied to abdominal surgery with favorable results. Application of this technology to our practice of thoracoscopy is the basis of this report. Videothoracoscopy has been performed in 39 patients for the following indications: chronic pleural effusion, interstitial lung disease, mediastinal lymphadenopathy in lung cancer, persistent air leak after decortication, mediastinal mass, recurrent spontaneous pneumothorax, hydropneumothorax with persistent air leak, and pleural-based mass. The technique we employ includes lateral decubitus positioning and double-lumen endotracheal intubation with ipsilateral lung collapse. The videoscope, retractors, and instruments are introduced through separate 10-mm incisions. Percutaneous manipulation of instruments and the videoscope is guided by images produced on television screens without dissection, and if resection is performed, the incision is enlarged to allow specimen retrieval. Procedures performed using this technique include pleural biopsy, partial pleurectomy, lysis of adhesions, lung biopsies, staging lymph node biopsy, lung nodule biopsy, pleural-based mass resection, and mediastinal mass biopsy and resection. This videoendoscopic technique greatly improves visualization of thoracic anatomy, facilitating thoracoscopy and enhancing exploration of the chest. It is preferred over conventional thoracoscopy and, in some patients, reduces the magnitude of operation by avoiding thoracotomy.

Adult↗
PubMed1991

Internal mammary artery graft at reoperation: risks, benefits, and methods of preservation.

To determine the effect of a prior internal mammary artery (IMA) graft on coronary artery bypass reoperation (CABR), we reviewed our experience with 410 consecutive patients: 313 received only saphenous vein grafts at initial coronary artery bypass grafting (CABG), and 97 received at least one IMA graft at CABG. Cardiac catheterization data before CABG were available in 110 patients (56 received only saphenous vein grafts, 54 received at least one IMA graft), allowing comparison of left ventricular function at CABG and CABR. Injury of the IMA graft occurred in 5 patients (1 death), but presence of an IMA graft was not an independent predictor of morbidity or mortality. Overall, the incidences of complications and deaths were higher in patients with saphenous vein grafts than in patients with IMA grafts, though not significantly so. Internal mammary artery grafts better preserved cardiac function: patients with IMA grafts had worse left ventricular function before CABG but better left ventricular function before CABR than patients with saphenous vein grafts. Left ventricular function deterioration from before CABG to before CABR was significantly less in patients with IMA grafts. We conclude that the risk of CABR is not increased by a previously constructed IMA graft and that left ventricular function is better preserved at CABR when an IMA graft was constructed at the initial operation.

Confounding Factors, Epidemiologic↗
PubMed1989

Experimental aortic replacement with a vascularized tissue graft.

Prosthetic graft infection in the aortic position remains a catastrophic complication of aortic replacement. In an effort to incorporate the advantages of vascularized tissue into aortic replacement, the practionally of infrarenal aortic replacement was investigated in dogs by a vascularized, musculofascial, pedicle graft. Eight dogs underwent laparotomy, and the left rectus abdominus muscle, its posterior rectus sheath, and underlying peritoneum were used to construct a tube graft based on the inferior epigastric vascular pedicle. A 2- to 4-cm section of the infrarenal aorta was resected, and the tube graft was interposed. Aortography documented graft patency immediately and at 1,6, and 10 months. Gross and histologic examination of the grafts at one month revealed viable skeletal muscle in the pedicle graft, with a thin layer of fibrin deposition on the luminal surface. Ten months after insertion, the microscopic examination against revealed patent vessels in the graft and a neoendothelial layer that lined the luminal surface of the graft. Successful replacement of the dog infrarenal aorta can be performed using a tube graft as part of a vascularized, musculofascial, pedicle flap. The potential for its use in the infected field is intriguing and deserves further study.

Animals↗
PubMed1988

Successful single lung transplantation.

We have presented a successful case of lung transplantation in a man with pulmonary fibrosis. We believe it is the first successful attempt in the United States, following demonstration of its feasibility in Toronto, Canada. Twenty years after the first lung transplantation, several factors have evolved that help to secure a successful outcome, including a strong, dynamic organ procurement system; static, hypothermic lung preservation; omental wrapping of the bronchial anastomosis; improved immunosuppressive agents; and improved postoperative care.

Humans↗
PubMed1987

Simultaneous resection of synchronous bilateral bronchogenic carcinoma using median sternotomy.

Despite the increasing use of median sternotomy for pulmonary resection, only two successful cases of simultaneous resection of bilateral primary bronchogenic carcinoma by this approach have been reported. We report the third case of successful resection of synchronous primary bronchogenic carcinoma by median sternotomy, and the fourth successful case of simultaneous resection, as the first reported case of simultaneous resection was accomplished via bilateral anterolateral thoracotomy incisions. We believe at present that the ideal surgical approach for patients with bilateral primary bronchogenic carcinoma is simultaneous resection by median sternotomy.

Carcinoma, Bronchogenic↗