Thymic resection with veins: case demonstrations and review of the literature.

Locally invasive thymic neoplasms are challenging clinical scenarios and typically require a multidisciplinary approach. The involvement of major mediastinal veins such as the superior vena cava (SVC) used to be a contraindication to surgery, but with improved surgical technique and outcomes, this paradigm has shifted. In some situations, complex resections and reconstructions may be indicated and required to improve the long-term outcome of these patients.

Gender trends in cardiothoracic surgery authorship.

Objective: In recent years, the historically low proportion of women cardiothoracic surgeons and trainees has been a subject of intense focus. Publications remain a key metric of academic success and career advancement. We sought to identify trends in the gender of first and last author publications in cardiothoracic surgery.

Extended Resections for Lung Cancer.

This article briefly reviews the literature supporting the practice of extended pulmonary resection followed by a comprehensive description of the indications, workup, and technique commonly used for patients requiring extended pulmonary resections for advance lung cancers. The article also provides up-to-date advances in the field that have aided in the safe and effective practice of extended pulmonary resections.

Gender trends of military general surgery residency applicants.

Background: Despite the fact that women comprise half of medical school graduates, women remain under-represented in General Surgery. We aimed to identify the trend in military general surgery applicants based on gender.

Methods: A retrospective review of the Medical Operational Data System (MODS) applicants from 2014 to 2019 was performed.

Thoracoscopic Radial Diaphragm Plication.

In appropriately selected patients diaphragm plication improves quality of life by alleviating dyspnea and allowing patients to return to their routine activities. Many plication techniques exist, but the optimal surgical approach remains unclear. We report our experience with a minimally invasive radial diaphragm plication technique.

Gender Differences in Medical Specialty Decision Making: The Importance of Mentorship.

Introduction: While there have been many studies reviewing factors considered by medical students in deciding on a specialty, there is a relative paucity of data in how these factors differ between males and females. The aim of this study was to determine if there are differences in how male and female medical students' value various factors in choosing a career path in medicine.

Methods: A survey of basic demographic information and a Likert-based questionnaire addressing various factors in specialty choice was sent to all military medical students in the class of 2019.

Panniculectomy after bariatric surgical weight loss: Analysis of complications and modifiable risk factors.

Introduction: Bariatric surgery results in massive weight loss, leaving many patients with redundant skin that can cause significant physical and psychosocial limitations. We sought to identify variables associated with postoperative complications and adjuncts associated with the mitigation of postoperative complications.

Methods: A retrospective review was performed of all post-bariatric surgery patients who underwent panniculectomy over a 10-year period.

Assessing serum hemoglobin levels without venipuncture: accuracy and reliability of Pronto-7 noninvasive spot-check device.

Background: Hemoglobin is a frequently obtained test in hospital settings. We analyzed accuracy of a noninvasive device compared to standard laboratory analyzers in a variety of settings.

Methods: A noninvasive hemoglobin monitoring device was analyzed for reliability, correlation, precision, and bias.

Reliability of Continuous Non-Invasive Assessment of Hemoglobin and Fluid Responsiveness: Impact of Obesity and Abdominal Insufflation Pressures.

Background: During surgery, proper fluid resuscitation and hemostatic control is critical. Pleth variability index (PVI) is advocated as a reliable way of optimizing intraoperative fluid resuscitation. PVI is a measure of dynamic change in perfusion index during a complete respiratory cycle.

Standard laparoscopic trocars for the treatment of tension pneumothorax: a superior alternative to needle decompression.

Background: Needle thoracostomy (NT) is a commonly taught intervention for tension pneumothorax (tPTX) but has a high failure rate. We hypothesize that standard 5-mm laparoscopic trocars may be a safe and more effective alternative.

Methods: Thirty episodes of tPTX and 27 episodes of tension-induced pulseless electrical activity (PEA) were induced in five adult swine using thoracic CO2 insufflation via balloon trocar.

Acute coagulopathy in a porcine venous hemorrhage and ischemia reperfusion model.

Background: Injury-related coagulopathy is a complex process. We analyzed coagulation in a swine model of shock using rotational thromboelastometry (ROTEM).

Methods: Forty-eight swine underwent laparotomy, 35% hemorrhage, supraceliac aortic cross-clamp, then reperfusion and resuscitation.

Tranexamic acid corrects fibrinolysis in the presence of acidemia in a swine model of severe ischemic reperfusion.

Background: Tranexamic acid (TXA) is an antifibrinolytic with anti-inflammatory properties associated with improved outcomes when administered to trauma patients at risk for bleeding; however, its efficacy is unknown in acidemia. We evaluated the efficacy of TXA on hyperfibrinolysis using an established porcine traumatic hemorrhage ischemic shock model.

Methods: Ten Yorkshire swine underwent a controlled hemorrhage followed by supraceliac aortic cross-clamping.

Perioperative protocols in colorectal surgery.

The reduction in health-care expenditures and more efficient use of medical resources are now overriding health policy priorities with the two-pronged goal of improving patient outcomes while decreasing overall cost. Current reports show colorectal surgery accounting for 25% of all operative complications and an average length of stay of 8 to 12 days for a standard elective colon resection. To combat this, Kehlet and colleagues introduced a concept of enhanced recovery after surgery (ERAS) or fast-track pathways, with the goal of using current evidence and multimodal therapies to decrease surgical stress, enhance postoperative recovery, and reduce length of stay.

Outcome comparison following colorectal cancer surgery in an equal access system.

Background: Previous reports suggest outcome differences following surgery for colorectal cancer (CRC) based on specialist and volume-related metrics. We sought to compare community and tertiary centers in an equal access system.

Materials And Methods: Patients treated for CRC at Department of Defense medical facilities were stratified by care at tertiary (MEDCEN) versus community (MEDDAC) medical centers.

Colorectal cancer screening in an equal access healthcare system.

Introduction: The military health system (MHS) a unique setting to analyze implementation programs as well as outcomes for colorectal cancer (CRC). Here we look at the efficacy of different CRC screening methods, attributes and results within the MHS, and current barriers to increase compliance.

Materials And Methods: A literature search was conducted utilizing PubMed and the Cochrane library.

Hypertension-linked decrease in the expression of brain gamma-adducin.

Gene profiling data coupled with adducin polymorphism studies led us to hypothesize that decreased expression of this cytosolic protein in the brain could be a key event in the central control of hypertension. Thus, our objectives in the present study were to (1) determine which adducin subunit gene demonstrates altered expression in the hypothalamus and brainstem (two cardioregulatory-relevant brain areas) in two genetic strains of hypertensive rats and (2) analyze the role of adducins in neurotransmission at the cellular level. All three adducin subunits (alpha, beta, and gamma) were present in the hypothalamus and brainstem of Wistar Kyoto (WKY) and spontaneously hypertensive (SH) rats.