Contemporary Video-Assisted Thoracoscopic Lobectomy for Early-Stage Lung Cancer.

The treatment of non-small cell lung cancer (NSCLC) has evolved tremendously in recent decades as innovations in medical therapies advanced concomitantly with minimally invasive surgical techniques. Despite early skepticism regarding its benefits, video-assisted thoracoscopic surgery (VATS) techniques for the surgical resection of early-stage NSCLC have now become the standard of care. After being the subject of many studies since its inception, VATS has been shown to cause less postoperative pain, have shorter recovery time, and have fewer overall complications when compared to conventional open approaches.

Minimally Invasive with Maximal Yield: A Narrative Review of Current Practices in Mediastinal Lymph Node Staging in Non-Small Cell Lung Cancer.

Lung cancer remains the leading cause of cancer deaths in the United States despite declining incidence and improved outcomes because of advancements in early detection and development of novel therapies. Accurate mediastinal lymph node staging is crucial for determining prognosis and guiding treatment decisions, particularly for non-small cell lung cancer (NSCLC). A systematic search of PubMed was conducted to identify English language articles published between January 2010 and January 2024 focusing on preoperative lymph node staging in adults with NSCLC.

Cardiothoracic Surgical Volume Within the Military Health System: Fiscal Years 2007 to 2017.

Background: Cardiothoracic surgical services have been provided at 7 military treatment facilities over the past decade. Accurate case volume data for adult cardiac and general thoracic surgical service lines in the Military Health System is unknown.

Methods: We queried the Military Health System Data Repository for adult cardiac and general thoracic cases performed at military treatment facilities in the Military Health System and surrounding purchased care markets for fiscal years 2007 to 2017.

Emergency Resuscitative Thoracotomy in the Combat or Operational Environment.

Resuscitative thoracotomy has been extensively described in the civilian trauma literature and has a high mortality rate, due largely to the nature of the injuries leading to arrest. The survival rates are generally highest (10-30%) for penetrating truncal injuries and patients who arrive with vital signs and proceed to arrest or who have impending arrest. They are significantly lower (less than 5%) for blunt trauma victims, particularly those who arrest in the field or during transport (1% or less).

Valvular Heart Disease.

This article outlines the diagnosis and management of commonly occurring valvular heart diseases for the primary care provider. Basic understanding of pathologic murmurs is important for appropriate referral. Echocardiography is the gold standard for diagnosis and severity grading.

A new perspective on metals and other contaminants in fluoridation chemicals.

Background: Fluoride additives contain metal contaminants that must be diluted to meet drinking water regulations. However, each raw additive batch supplied to water facilities does not come labeled with concentrations per contaminant. This omission distorts exposure profiles and the risks associated with accidents and routine use.

Imaging presentation of complicated diabetic ketoacidosis: a case report.

Spontaneous pneumomediastinum is a fairly uncommon complication of diabetic ketoacidosis. Knowledge of the clinical and radiographic manifestation is important for the proper management of patients since the disease usually follows a benign evolution. We report a case of a 20-year-old soldier who presented with a pneumomediastinum that was initially falsely attributed to a motor vehicular crash.

A new heart: somatic stem cells and myocardial regeneration.

End-stage heart failure is a global scourge. Current therapies merely delay its inexorable progression. Heart transplantation is resource-intensive and limited by organ availability.

Rare anatomic location of a papillary fibroelastoma.

A rare anatomic location of a fibroelastoma arising form the edge of the right atrial wall near the atrioventricular node and the base of the septal leaflet of the tricuspid valve is presented. Complete surgical excision remains the goal with a precise and careful technique to ensure conduction integrity.

Pannus-related prosthetic valve dysfunction and life-threatening aortic regurgitation.

Prosthetic valve dysfunction is a rare but life-threatening condition. A 66-year-old woman presented with shock 15 years after aortic valve replacement with a tilting-disc valve. Imaging demonstrated severe aortic insufficiency and a fixed-open prosthetic valve.

A comparison of open versus closed techniques using the Harmonic Scalpel in outpatient hemorrhoid surgery.

Background: Surgical excision using the Harmonic Scalpel is a modern technique for symptomatic third- and fourth-degree hemorrhoids. The resulting mucosal defect is then left open or sutured closed depending on surgeon preference.

Purpose: The purpose of this study was to compare the open vs.

Prehospital tourniquet use in Operation Iraqi Freedom: effect on hemorrhage control and outcomes.

Background: Up to 9% of casualties killed in action during the Vietnam War died from exsanguination from extremity injuries. Retrospective reviews of prehospital tourniquet use in World War II and by the Israeli Defense Forces revealed improvements in extremity hemorrhage control and very few adverse limb outcomes when tourniquet times are less than 6 hours.

Hypothesis: We hypothesized that prehospital tourniquet use decreased hemorrhage from extremity injuries and saved lives, and was not associated with a substantial increase in adverse limb outcomes.

Selective nonoperative management of penetrating torso injury from combat fragmentation wounds.

Background: Historically, military surgical doctrine has mandated exploratory laparotomy for all penetrating fragmentation wounds. We hypothesized that stable patients with abdominal fragmentation injuries whose computerized tomography (CT) scans for intraperitoneal or retroperitoneal penetration disclosed nothing abnormal, can be safely observed without therapeutic laparotomy.

Methods: We retrospectively studied all hemodynamically stable patients with penetrating fragmentation wounds to the back, flank, lower chest, abdomen, and pelvis evaluated by abdominal physical examination (PE), CT, or ultrasound treated during a 6-month period at one combat support hospital.

A prospective evaluation of C-reactive protein in the progression of carotid artery stenosis.

Objective: Our institution previously reported an association between elevated C-reactive protein (CRP) and carotid artery stenosis. Based on this finding, we sought to further evaluate the association of CRP levels with ultrasound progression of carotid artery stenosis, and/or clinical events.

Methods: A prospective observational study of patients evaluated for carotid artery stenosis was performed at a tertiary medical center from 2003-2007.

C-reactive protein level and traditional vascular risk factors in the prediction of carotid stenosis.

Hypothesis: There is no relationship between C-reactive protein (CRP) level and the presence and degree of carotid stenosis (null hypothesis).

Design: Institutional review board-approved cohort study.

Setting: Tertiary care regional medical center.

Colon and rectal injuries during Operation Iraqi Freedom: are there any changing trends in management or outcome?

Purpose: Despite the evolution in the management of traumatic colorectal injuries in both civilian and military settings during the previous few decades, they continue to be a source of significant morbidity and mortality. The purpose of this study was to analyze management and clinical outcomes from a cohort of patients suffering colorectal injuries.

Methods: This was a retrospective analysis of prospectively collected data from all patients injured and treated at the 31st Combat Support Hospital during Operation Iraqi Freedom from September 2003 to December 2004.

Operative management and outcomes of traumatic lung resection.

Background: To analyze the presentation, injury patterns, and outcomes among a large cohort of patients requiring lung resection for trauma, and to compare outcomes stratified by the extent of resection.

Study Design: Review of all adult patients undergoing lung resections in the National Trauma Data Bank. Patients were categorized by extent of lung resection; wedge resection, lobectomy, or pneumonectomy.

Modified sternotomy to minimize infection risk in patients with prior laryngectomy and permanent tracheostomy.

Patients with prior laryngectomy and permanent tracheostomy undergoing complete sternotomy historically are at increased risk for wound infection, osteomyelitis, mediastinitis, bleeding, tracheal injury, and poor wound healing. We describe three patients who underwent cardiac surgery via low midline incision with transverse flap, providing the exposure of complete sternotomy and decreased infectious risk. Patient selection, technique, and management principles are discussed.

Limb salvage and outcomes among patients with traumatic popliteal vascular injury: an analysis of the National Trauma Data Bank.

Purpose: Popliteal arterial trauma carries the greatest risk of limb loss of any peripheral vascular injury. The purpose of this study was to analyze outcomes after popliteal arterial injuries and identify factors contributing to disability.

Methods: A retrospective analysis was conducted of prospectively collected trauma data from the National Trauma Data Bank (NTDB).

Rapid high-volume population screening for three major risk factors of future stroke: phase I results.

Three proximate risk factors for stroke are carotid stenosis, atrial fibrillation, and hypertension. Phase I of this prospective study was designed to establish the prevalence of these conditions among a population of health maintenance organization beneficiaries by using a rapid screening protocol in order to risk-stratify patients for appropriate management and subsequent cohort analysis. Patients at a tertiary care medical center were screened for stroke risk by using directed history, a 3-minute carotid "quick-scan'' protocol, an EKG lead II rhythm strip, and bilateral arm blood pressures.

Splanchnic perfusion pressure: a better predictor of safe primary closure than intraabdominal pressure in neonatal gastroschisis.

Background/purpose: Both measured intraabdominal pressure (IAP) and calculated splanchnic perfusion pressure (SPP) have been advocated for use in operative management of gastroschisis. We directly compared these 2 clinical indices.

Methods: Institutional review board-approved multi-institutional retrospective review from 3 centers with 112 subjects.