Longitudinal Health-related Quality of Life among Individuals Considering Treatment for Stage I Non-Small-Cell Lung Cancer.

Because of improvements in screening, there is an increasing number of patients with early-stage non-small-cell lung cancer (NSCLC) who are making treatment decisions. Among patients with suspected stage I NSCLC, we evaluated longitudinal patient-centered outcomes (PCOs) and the association of changes in PCOs with treatment modality, stereotactic body radiotherapy (SBRT) compared with surgical resection. We conducted a multisite, prospective, observational cohort study at seven medical institutions.

Distal Ventriculoatrial Shunt Revision in Adult Myelomeningocele Patient Performed via Endovascular Transvenous Approach.

Background: Myelomeningocele patients with shunt-dependent hydrocephalus often require multiple shunt revisions, eventually exhausting first-line distal diversion sites. Ventriculoatrial (VA) shunts are used less commonly than ventriculoperitoneal shunts, but knowledge of their use and complications is important to the neurosurgeon's armamentarium. VA shunts differ from ventriculoperitoneal and ventriculopleural shunts in that the ideal distal catheter target is an anatomically small area in comparison with the peritoneal and pleural cavities.

Safe delivery of lung stereotactic body radiation therapy in a patient with a left ventricular assist device and implantable cardioverter defibrillator.

This is the first case to discuss the safe delivery of stereotactic body radiation therapy to a left lower lobe lung nodule in a patient with a third generation left ventricular assist device (Heartware) and implantable cardioverter defibrillator.

Thoracoscopic truncal vagotomy versus surgical revision of the gastrojejunal anastomosis for recalcitrant marginal ulcers.

Introduction: Marginal ulcer is a common complication following Roux-en-Y gastric bypass with incidence rates between 1 and 16%. Most marginal ulcers resolve with medical management and lifestyle changes, but in the rare case of a non-healing marginal ulcer there are few treatment options. Revision of the gastrojejunal (GJ) anastomosis carries significant morbidity with complication rates ranging from 10 to 50%.

Gastric Ischemic Conditioning Prior to Esophagectomy Is Associated with Decreased Stricture Rate and Overall Anastomotic Complications.

Background: Gastric ischemic conditioning prior to esophagectomy can increase neovascularization of the new conduit. Prior studies of ischemic conditioning have only investigated reductions in anastomotic leaks. Our aim was to analyze the association between gastric conditioning and all anastomotic outcomes as well as overall morbidity in our cohort of esophagectomy patients.

VIDEO: Rethinking "Mural Thickening:" Vasculitis or Aortic Dissection?

Objective: The objective of this video article is to provide education about the similarities and differences between vasculitis and rare, acute aortic pathologic findings so that an appropriate diagnosis can be made in a timely manner, especially for patients with life-threatening aortic pathologic findings.

Conclusion: Although they are rare, acute aortic pathologic findings, such as aortic dissection and intramural hematoma, can have radiographic characteristics similar to those of vasculitis, which can make it challenging to discern between these vastly different diagnoses without the use of properly timed imaging studies.

Sarcopenia is not associated with morbidity, mortality, or recurrence after esophagectomy for cancer.

Background: Sarcopenia is associated with increased morbidity and mortality in hepatic, pancreatic and colorectal cancer. We examined the effect of sarcopenia on morbidity, mortality, and recurrence after resection for esophageal cancer.

Methods: Retrospective review of consecutive esophagectomies from 2010 to 2015.

Patient-clinician communication among patients with stage I lung cancer.

Purpose: Limited data exist about patient-centered communication (PCC) and patient-centered outcomes among patients who undergo surgery or stereotactic body radiation therapy (SBRT) for stage I non-small cell lung cancer (NSCLC). We aimed to examine the relationship between PCC and decision-making processes among NSCLC patients, using baseline data from a prospective, multicenter study.

Methods: Patients with stage 1 NSCLC completed a survey prior to treatment initiation.

"It wasn't as bad as I thought it would be": a qualitative study of early stage non-small cell lung cancer patients after treatment.

Objective: While surgical resection is recommended for most patients with early stage lung cancer, stereotactic body radiotherapy (SBRT) is being increasingly utilized. Provider-patient communication regarding risks/benefits of each approach may be a modifiable factor leading to improved patient-centered outcomes. Our objective was to determine a framework and recommended strategies on how to best communicate with patients with early stage non-small cell lung cancer (NSCLC) in the post-treatment setting.

Evolution in the Treatment of Esophageal Disease at a Single Academic Institution: 2004-2013.

Introduction: Management of benign and malignant esophageal disease has changed rapidly over the past decade. The aim of this study was to analyze evolution in surgical management of esophageal disease at a single academic medical center during this period.

Materials And Methods: We reviewed a retrospective cohort of patients who underwent esophagectomy between 2004 and 2013.

Acute Chest Wall Infections: Surgical Site Infections, Necrotizing Soft Tissue Infections, and Sternoclavicular Joint Infection.

Acute chest wall infections are uncommon and share similar risk factors for infection at other surgical sites. Smoking cessation has been shown to decrease the risk of surgical site infection. Depending on the depth of infection and/or involvement of the organ space, adequate therapy involves antibiotics and drainage.

The role of bronchoscopy in the diagnosis of airway disease.

Endoscopy of the airway is a valuable tool for the evaluation and management of airway disease. It can be used to evaluate many different bronchopulmonary diseases including airway foreign bodies, tumors, infectious and inflammatory conditions, airway stenosis, and bronchopulmonary hemorrhage. Traditionally, options for evaluation were limited to flexible and rigid bronchoscopy.

Extraction of a Large Central Airway Foreign Body Using Flexible Bronchoscopy Combined with an Endobronchial Blocker.

Adult foreign body (FB) aspiration is an uncommon but potentially fatal event. Options for extraction include flexible bronchoscopy (FLXB), rigid bronchoscopy (RB), and surgical extraction. We report the case of a large, smooth aspirated rock causing airway obstruction in an elderly male.

"Even if I Don't Remember, I Feel Better". A Qualitative Study of Patients with Early-Stage Non-Small Cell Lung Cancer Undergoing Stereotactic Body Radiotherapy or Surgery.

Rationale: While surgical resection is recommended for most patients with early stage lung cancer according to the National Comprehensive Cancer Network guidelines, stereotactic body radiotherapy is increasingly being used. Provider-patient communication regarding the risks and benefits of each approach may be a modifiable factor leading to improved patient-centered outcomes.

Objectives: To qualitatively describe the experiences of patients undergoing either surgery or stereotactic body radiotherapy for early stage non-small cell lung cancer.

Presumed Second Focus of Lung Immunoglobulin G4-Related Disease Found to be Adenocarcinoma.

We describe a patient presenting with bilateral radiologically similar lung lesions initially diagnosed as immunoglobulin (Ig) G4-related disease from biopsy of one lesion, but radiographic changes 6 months later prompted biopsy of the second lesion and showed adenocarcinoma. No case of lung IgG4-related disease and a distant lung malignancy has been previously reported. This is notable because lung IgG4-related disease often manifests in multiple thoracic locations but is diagnosed from a representative biopsy specimen.

Increasing tumor length is associated with regional lymph node metastases and decreased survival in esophageal cancer.

Background: Although tumor length has received little attention for staging of esophageal cancer, it may be a valid prognostic feature for node positivity and survival.

Methods: Through retrospective review of a prospective institutional database, esophageal cancer patients who completed esophagectomy without neoadjuvant chemoradiation were analyzed. Pathologic tumor lengths were compared with node positivity and survival through a zero-inflated negative binomial regression model and multivariable Cox proportional hazards model, respectively.

Lymph Node Harvest During Esophagectomy Is Not Influenced by Use of Neoadjuvant Therapy or Clinical Disease Stage.

Introduction: The purpose of this study was to evaluate the effects of neoadjuvant therapy on lymph node harvest (LNH), lymph node ratio (LNR), and overall survival rates after esophagectomy.

Methods: A retrospective analysis of 111 patients who underwent esophagectomy for esophageal adenocarcinoma from 2001 to 2010 was performed. Patients were divided into two groups: neoadjuvant chemoradiotherapy prior to surgery (NEOSURG) versus surgery alone (SURG).

Impact of comorbidity on outcomes and overall survival after open and minimally invasive esophagectomy for locally advanced esophageal cancer.

Background: The aim of this study was to examine the impact of the Charlson Comorbidity Index-Grade (CCI-G) on predicting outcomes and overall survival after open and minimally invasive esophagectomy (MIE).

Methods: One hundred and forty-six patients who underwent esophagectomy between 1995 and 2011 for stage II and III cancer were selected and separated into open esophagectomy (Open) and MIE groups. Risk adjustment was performed using the CCI-G.

Penetrating neck injury to the superior thoracic artery managed by video-assisted thoracoscopic surgery.

Penetrating trauma to the axillary artery and its branches is uncommon and associated with high morbidity and mortality. Open exploration is mandated in hemodynamically unstable patients, but surgical exposure can be difficult due to the concentration of vital structures and complex anatomy in this region. Computed tomographic angiography is a potential diagnostic modality in hemodynamically stable patients.

Specialty matters in the treatment of lung cancer.

The effect of surgeon volume, hospital volume, and surgeon specialty on operative outcomes has been reported in numerous studies. Short-term and long-term outcome comparisons for pulmonary resection for lung cancer have been performed between general surgeons (GS), cardiothoracic surgeons (CTS), and general thoracic surgeons (TS), using large administrative and inpatient databases. In the United States, general surgeons perform more pulmonary resection than thoracic surgeons.

Management of cricopharyngeal dysphagia with and without Zenker's diverticulum.

Cricopharyngeal dysphagia and Zenker 's diverticulum result from cricopharyngeal dysfunction, a failure of the upper esophageal sphincter to relax at the initiation of swallowing. The focus of surgical management involves a cricopharyngeal myotomy that is performed by either an open or an endoscopic approach. The endoscopic approach offers faster operating times, a shorter hospital stay, earlier time to oral intake, and lower complication rates, but a role for open cricopharyngeal myotomy remains.

Mediastinal hemangioma arising in setting of partial anomalous pulmonary venous drainage to azygous vein in a 57-year-old woman.

Partial anomalous pulmonary venous drainage (PAPVD) to the azygous vein and benign posterior mediastinal hemangioma in adults are both rare entities in isolation. The coexistence of these two lesions in the same patient has not been reported. We describe a unique case of PAPVD to the azygous vein in an adult woman, where the anomalous left inferior pulmonary vein transited first through a large hemangioma, and then eventuated in the azygous vein.

Testing of blood products in a polytrauma model: results of a multi-institutional randomized preclinical trial.

Introduction: Trauma-induced coagulopathy, acidosis, and hypothermia form a "lethal triad" that is difficult to treat and is associated with extremely high mortality. This study was performed at three academic centers to evaluate whether resuscitation with blood components could reverse the coagulopathy in a complex polytrauma model.

Methods: Yorkshire swine (40 +/- 5 kg) were subjected to a three-phase protocol: (a) "Prehospital" phase = femur fracture, hemorrhage (60% blood volume), and 30 minutes shock + infusion of saline (3x shed blood) + induction of hypothermia (33 degrees C); (b) "Early hospital" phase = grade V liver injury; and (c) "Operative" phase= liver packing.