Thoracic Surgery Outcomes Research Network (ThORN) Consensus Document on Defining a High Quality Wedge Resection for Early Stage Lung Cancer.

With the publication of CALGB 140503, an increase in wedge resections for small, peripheral non-small cell lung cancer is expected; however, a relative paucity of data exists as to what defines a high quality oncologic wedge resection. The Thoracic Surgery Outcomes Research Network (ThORN), through expert discussion, guided by review of what limited data does exist, and through use of a modified Delphi process, provides these consensus statements defining an oncologically sound, high quality wedge resection. The statements are classified into five categories: 1) Preoperative Considerations 2) Technical Aspects 3) Lymph Node Assessment 4) Margin Assessment and 5) Tissue Handling by Pathology.

Extracorporeal Membrane Oxygenation Without Mechanical Ventilation for Recovery From Tracheal Repair.

Postoperative positive pressure ventilation (PPV) can contribute to failure of large intrathoracic airway repairs. We report a case of a 67-year-old woman with severe emphysema who presented with an unstable airway and mediastinitis after full-length transmural intrathoracic tracheal intubation injury. After repair, neither extubation nor PPV distal to the repair was feasible.

A Brief Historical Perspective on Pulmonary Embolism.

Pulmonary embolism is a major cause of mortality worldwide. In this historical perspective, we aim to provide an overview of the rich medical history surrounding pulmonary embolism. We highlight Virchow's first steps toward understanding the pathophysiology in the 1800s.

One hundred cases of primary spontaneous pneumomediastinum: leukocytosis is common, pleural effusions and age over 40 are rare.

Background: Primary spontaneous pneumomediastinum (PSPM) is a benign condition, but it can be difficult to discriminate from Boerhaave syndrome. The diagnostic difficulty is attributable to a shared constellation of history, signs, and symptoms combined with a poor understanding of the basic vital signs, labs, and diagnostic findings characterizing PSPM. These challenges likely contribute to high resource utilization for diagnosis and management of a benign process.

Mini-open lateral retropleural thoracic discectomy approach.

The lateral retropleural approach provides an eloquent, mini-open, safe corridor to address various pathologies in the thoracolumbar spine, including herniated thoracic discs. Traditional approaches (e.g.

Supracerebellar Infratentorial Approach for a Malignant Pineal Region Tumor Mimicking a Cavernous Malformation.

A man in his early 20s presented with diplopia. Imaging revealed a pineal region hemorrhagic lesion, suggestive of cavernous malformation. The patient underwent an endoscopic third ventriculostomy and was transferred to our institution.

Should Somatosensory and Motor Evoked Potential Monitoring Be Used Routinely in All Posterior Cervical Operations for Degenerative Conditions of the Cervical Spine?

Objective: Intraoperative neuromonitoring (IONM) is useful during spinal cord operations, but whether IONM is necessary for posterior cervical surgeries for degenerative conditions is unknown. We evaluated the utility of somatosensory evoked potential (SSEP) and motor evoked potential (MEP) monitoring as a tool for predicting new postoperative neurologic deficits during posterior decompression and fusion for degenerative cervical spine conditions.

Methods: We retrospectively reviewed posterior cervical operations performed at our institute over a 4-year period.

Outpatient outcomes of patients with femoral nerve neurapraxia after prone lateral lumbar interbody fusion at L4-5.

Objective: Single-position prone lateral lumbar interbody fusion (LLIF) improves the efficiency of staged minimally invasive lumbar spine surgery. However, laterally approaching the lumbar spine, especially L4-5 with the patient in the prone position, could increase the risk of complications and presents unique challenges, including difficult ergonomics, psoas migration, and management of the nearby lumbar plexus. The authors sought to identify postoperative femoral neurapraxia after single-position prone LLIF at L4-5 to better understand how symptoms evolve over time.

Development of a novel miR-3648-related gene signature as a prognostic biomarker in esophageal adenocarcinoma.

Background: Esophageal adenocarcinoma (EA) is a typical immunogenic malignant tumor with a dismal 5-year survival rate lower than 20%. Although miRNA-3648 (miR-3648) is expressed abnormally in EA, its impact on the tumor immune microenvironment remains unknown. In this study, we sought to identify immune-related genes (IRGs) that are targeted by miR-3648 and develop an EA multigene signature.

A narrative review of primary spontaneous pneumomediastinum: a poorly understood and resource-intensive problem.

Primary spontaneous pneumomediastinum (PSPM) is a benign self-limited condition that can be difficult to discriminate from esophageal perforation. This may trigger costly work-up, transfers and hospital admissions. To better understand this diagnostic dilemma and current management, we undertook the most comprehensive and up to date review of PSPM.

What Can We Learn From More Than 140,000 Moments of Ecological Momentary Assessment-Assessed Negative Emotion and Ambulatory Blood Pressure? A Systematic Review and Meta-Analysis.

Objective: Two decades of research has examined within-person associations between negative emotion states and ambulatory blood pressure (ABP) using ecological momentary assessment (EMA), but no meta-analysis has been conducted. We conducted this systematic review and meta-analysis to quantify the magnitude of this association and identify moderators, review strengths and weaknesses in conceptual and measurement approaches, and provide recommendations.

Methods: We searched databases (PsycINFO, PubMed), identified 15 studies, and obtained data from 13 studies (n = 2511; 142,307 observations).

Predictors of indirect neural decompression in minimally invasive transpsoas lateral lumbar interbody fusion.

Objective: An advantage of lateral lumbar interbody fusion (LLIF) surgery is the indirect decompression of the neural elements that occurs because of the resulting disc height restoration, spinal realignment, and ligamentotaxis. The degree to which indirect decompression occurs varies; no method exists for effectively predicting which patients will respond. In this study, the authors identify preoperative predictive factors of indirect decompression of the central canal.

Multimodal Sensing Capabilities for the Detection of Shunt Failure.

Hydrocephalus is a medical condition characterized by the abnormal accumulation of cerebrospinal fluid (CSF) within the cavities of the brain called ventricles. It frequently follows pediatric and adult congenital malformations, stroke, meningitis, aneurysmal rupture, brain tumors, and traumatic brain injury. CSF diversion devices, or shunts, have become the primary therapy for hydrocephalus treatment for nearly 60 years.

When Indirect Decompression Fails: A Review of 220 Consecutive Direct Lateral Interbody Fusions and Unplanned Secondary Decompression.

Study Design: A consecutive series of patients who underwent minimally invasive spinal surgery by a single surgeon at a high-volume academic medical center were studied.

Objective: The objective of this study was to identify the prevalence, radiographic features, and clinical characteristics of patients who require unplanned secondary decompressive laminectomy or foraminotomy after lateral lumbar interbody fusion (LLIF).

Summary Of Background Data: LLIF indirectly decompresses the spinal canal, lateral recess, and neural foramen when properly performed.

Cavitary lung lesions and pneumothorax in a healthy patient with active coronavirus-19 (COVID-19) viral pneumonia.

Severe respiratory sequelae drive morbidity-associated with coronavirus 2019 (COVID-19) disease. We report a case of COVID-19 pneumonia complicated by cavitary lesions and pneumothorax in a young healthy male. Pneumothorax management with catheter thoracostomy and rapid resolution of the cavitary lesions are described.

Standardized Ventriculostomy Protocol without an Occlusive Dressing: Results of an Observational Study in Patients with Aneurysmal Subarachnoid Hemorrhage.

Background: Catheter-related infections are a potentially life-threatening complication of having an external ventricular drain (EVD). Patients with aneurysmal subarachnoid hemorrhage (aSAH) are at increased risk of infection associated with prolonged ventricular drainage, with a reported mean infection rate of 6%. We report the EVD-associated infection rate among patients with aSAH managed with a unique standardized treatment protocol without an occlusive EVD dressing.

Selective posterior cerebral artery amobarbital test: a predictor of memory following subtemporal selective amygdalohippocampectomy.

Background: The selective posterior cerebral artery (PCA) amobarbital test, or PCA Wada test, is used to predict memory impairment after epilepsy surgery in patients who have previously had a failed internal carotid artery (ICA) amobarbital test.

Methods: Medical records from 2012 to 2018 were retrospectively reviewed for all patients with seizures who underwent a selective PCA Wada test at our institution following a failed or inconclusive ICA Wada test. Standardized neuropsychological testing was performed before and during the Wada procedure and postoperatively in patients who underwent resection.