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1.
Ann Surg ; 272(4): 583-588, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32657925

RESUMO

OBJECTIVE: To examine technical-, patient-, tumor-, and treatment-related factors associated with NIR guided SLN identification. BACKGROUND: Missed nodal disease correlates with recurrence in early stage NSCLC. NIR-guided SLN mapping may improve staging and outcomes through identification of occult nodal disease. METHODS: Retrospective analysis of 2 phase I clinical trials investigating NIR-guided SLN mapping utilizing ICG in patients with surgically resectable NSCLC. RESULTS: In total, 66 patients underwent NIR-guided SLN mapping and lymphadenectomy after peritumoral ICG injection. There was significantly increased likelihood of SLN identification with injection dose ≥1 mg compared to <1 mg (65.2% vs 35.0%, P = 0.05), lung ventilation after injection (65.2% vs 35.0%, P = 0.05), and albumin dissolvent (68.1%) compared to fresh frozen plasma (28.6%) and sterile water (20.0%) (P = 0.01). In patients receiving the optimized ICG injection, there was significantly increased likelihood of SLN identification with radiologically solid nodules compared to sub-solid nodules (77.4% vs 33.3%, P = 0.04) and anatomic resection compared to wedge resection (88.2% vs 52.2%, P = 0.04). Disease-free and overall survival are 100% in those with a histologically negative SLN identified (n = 25) compared to 73.6% (P = 0.02) and 63.6% (P = 0.01) in patients with node negative NSCLC established via routine lymphadenectomy alone (n = 22). CONCLUSIONS: SLN(s) are more reliably identified with ICG dose ≥1 mg, albumin dissolvent, post-injection lung ventilation, radiologically solid nodules, and anatomic resections. To date, N0 status when established via NIR SLN mapping seems to be associated with decreased recurrence and improved survival after surgery for NSCLC.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Carcinoma Pulmonar de Células não Pequenas/secundário , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Metástase Linfática/diagnóstico por imagem , Metástase Linfática/patologia , Linfonodo Sentinela/diagnóstico por imagem , Linfonodo Sentinela/patologia , Espectroscopia de Luz Próxima ao Infravermelho/métodos , Corantes , Humanos , Verde de Indocianina , Estudos Retrospectivos
2.
J Surg Res ; 206(1): 90-97, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27916381

RESUMO

BACKGROUND: Patients seeking health information commonly use the Internet as the first source for material. Studies show that well-informed patients have increased involvement, satisfaction, and healthcare outcomes. As one-third of Americans have only basic or below basic health literacy, the National Institutes of Health and American Medical Association recommend patient-directed health resources be written at a sixth-grade reading level. This study evaluates the readability of commonly accessed online resources on lung cancer. METHODS: A search for "lung cancer" was performed using Google and Bing, and the top 10 websites were identified. Location services were disabled, and sponsored sites were excluded. Relevant articles (n = 109) with patient-directed content available directly from the main sites were downloaded. Readability was assessed using 10 established methods and analyzed with articles grouped by parent website. RESULTS: The average reading grade level across all sites was 11.2, with a range from 8.8 (New Fog Count) to 12.2 (Simple Measure of Gobbledygook). The average Flesch Reading Ease score was 52, corresponding with fairly difficult to read text. The readability varied when compared by individual website, ranging in grade level from 9.2 to 15.2. Only 10 articles (9%) were written below a sixth-grade level and these tended to discuss simpler topics. CONCLUSIONS: Patient-directed online information about lung cancer exceeds the recommended sixth-grade reading level. Readability varies between individual websites, allowing physicians to direct patients according to level of health literacy. Modifications to existing materials can significantly improve readability while maintaining content for patients with low health literacy.


Assuntos
Compreensão , Informação de Saúde ao Consumidor , Internet , Neoplasias Pulmonares , Letramento em Saúde , Humanos
3.
Dermatol Online J ; 20(1): 21257, 2014 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-24456960

RESUMO

A simplified approach to treat venous lakes of the vermillion lip is presented. Our method involves the use of a 30 gauge hypodermic needle to deliver a low-powered, high-frequency electrical current from a hyfrecator power source into the venous lake lesion.


Assuntos
Eletrocirurgia/métodos , Lábio/irrigação sanguínea , Procedimentos Cirúrgicos Minimamente Invasivos , Varizes/cirurgia , Condutividade Elétrica , Eletrocirurgia/instrumentação , Estética , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Agulhas , Varizes/patologia , Vênulas/patologia
4.
J Thorac Cardiovasc Surg ; 165(6): 1919-1925, 2023 06.
Artigo em Inglês | MEDLINE | ID: mdl-36244821

RESUMO

OBJECTIVE: The advent of lung cancer screening and detection of smaller nodules amplifies the need to clarify the oncological quality of sublobar resections. Furthermore, studies comparing sublobar resections to lobectomies offer conflicting conclusions. We hypothesize that this is driven, in part, by inconsistency in reporting; that is, variable interpretation of what constitutes an operative segment. Without an established standard, 2 very different operations may be reported as segmental resections, leaving the data on sublobar approaches subject to interpretative variability. METHODS: A retrospective audit was performed on all segmental resections from May 2016 to December 2019 at Brigham and Women's Hospital. Pathology and operative reports were reviewed, with particular attention to the dissection of the component artery, vein, and bronchus. Resections with dissection and division of at least 1 major vascular structure (the segmental artery or vein), as well as the segmental bronchus, met operative criteria for anatomic segmentectomy. Surgical quality metrics were compared between the 2 groups. RESULTS: There were 271 segmental resections: 219 (80.8%) were anatomic segmentectomies and 52 (19.2%) were nonanatomic segmentectomies. For the entire cohort, nonanatomic segmentectomies had smaller margins (1.0 vs 1.5 cm; P = .02), fewer lymph nodes (2.0 vs 6.0; P < .001), and fewer mediastinal lymph node stations sampled (1.0 vs 2.0; P < .001). Similarly, there were smaller margins (1.5 vs 1.8 cm; P = .03), fewer lymph nodes (2.0 vs 6.0; P < .001), and fewer mediastinal lymph node stations sampled (1.0 vs 2.0; P < .001) in nonanatomic segmentectomies for non-small cell lung cancer. CONCLUSIONS: Nearly 20% of reported segmentectomies may not meet criteria for true segmental resection. Therefore, prior studies may need further scrutiny to clarify outcomes and results. Establishing a professional standard may help mitigate ambiguity in published data on this subject.


Assuntos
Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Humanos , Feminino , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Carcinoma Pulmonar de Células não Pequenas/patologia , Neoplasias Pulmonares/cirurgia , Neoplasias Pulmonares/patologia , Estudos Retrospectivos , Pneumonectomia/efeitos adversos , Pneumonectomia/métodos , Mastectomia Segmentar , Detecção Precoce de Câncer , Estadiamento de Neoplasias
5.
JTCVS Tech ; 6: 172-177, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33319213

RESUMO

OBJECTIVE: To develop a team-based institutional infrastructure for navigating management of a novel disease, to determine a safe and effective approach for performing tracheostomies in patients with COVID-19 respiratory failure, and to review outcomes of patients and health care personnel following implementation of this approach. METHODS: An interdisciplinary Task Force was constructed to develop innovative strategies for management of a novel disease. A single-institution, prospective, nonrandomized cohort study was then conducted on patients with coronavirus disease 2019 (COVID-19) respiratory failure who underwent tracheostomy using an induced bedside apneic technique at a tertiary care academic institution between April 27, 2020, and June 30, 2020. RESULTS: In total, 28 patients underwent tracheostomy with induced apnea. The median lowest procedural oxygen saturation was 95%. The median number of ventilated days following tracheostomy was 11. There were 3 mortalities (11%) due to sepsis and multiorgan failure; of 25 surviving patients, 100% were successfully discharged from the hospital and 76% are decannulated, with a median time of 26 days from tracheostomy to decannulation (range 12-57). There was no symptomatic disease transmission to health care personnel on the COVID-19 Tracheostomy Team. CONCLUSIONS: Patients with respiratory failure from COVID-19 disease may benefit from tracheostomy. This can be completed effectively and safely without viral transmission to health care personnel. Performing tracheostomies earlier in the course of disease may expedite patient recovery and improve intensive care unit resource use. The creation of a collaborative Task Force is an effective strategic approach for management of novel disease.

6.
J Thorac Oncol ; 13(6): 767-778, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29654928

RESUMO

The landscape of care for early-stage non-small cell lung cancer continues to evolve. While some of the developments do not seem as dramatic as what has occurred in advanced disease in recent years, there is a continuous improvement in our ability to diagnose disease earlier and more accurately. We have an increased understanding of the diversity of early-stage disease and how to better tailor treatments to make them more tolerable without impacting efficacy. The International Association for the Study of Lung Cancer and the Journal of Thoracic Oncology publish this annual update to help readers keep pace with these important developments. Experts in the care of early-stage lung cancer patients have provided focused updates across multiple areas including screening, pathology, staging, surgical techniques and novel technologies, adjuvant therapy, radiotherapy, surveillance, disparities, and quality of life. The source for information includes large academic meetings, the published literature, or novel unpublished data from other international oncology assemblies.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/terapia , Neoplasias Pulmonares/terapia , Carcinoma Pulmonar de Células não Pequenas/patologia , Humanos , Neoplasias Pulmonares/patologia , Estadiamento de Neoplasias
7.
Ophthalmic Surg Lasers Imaging Retina ; 45 Online: e23-5, 2014 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-24702759

RESUMO

A 44-year-old man presented with central retinal vein occlusion (CRVO) in his right eye after prolonged vomiting and repeated Valsalva maneuvers associated with gastroenteritis and dehydration. He had no other pertinent medical history, and a subsequent systemic and hematologic evaluation was within normal limits. At initial diagnosis, his visual acuity was 20/70 due to diffuse cystoid macular edema (CME) and nonischemic CRVO. After six monthly intravitreal bevacizumab injections, his vision improved to 20/20 and the CME greatly improved. An episode of prolonged vomiting and repeated Valsalva maneuvers may be a potential risk factor for CRVO in younger patients.


Assuntos
Desidratação/complicações , Gastroenterite/complicações , Oclusão da Veia Retiniana/etiologia , Manobra de Valsalva , Vômito/complicações , Adulto , Inibidores da Angiogênese/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Bevacizumab , Humanos , Injeções Intravítreas , Edema Macular/diagnóstico , Edema Macular/etiologia , Masculino , Oclusão da Veia Retiniana/diagnóstico , Tomografia de Coerência Óptica , Acuidade Visual/fisiologia
8.
Clin Case Rep ; 2(1): 10-3, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25356228

RESUMO

KEY CLINICAL MESSAGE: Nonorganic vision loss (NOVL) is a relatively common condition in pediatric patients. Prompt diagnosis can prevent costly, time-consuming, and frustrating workups. It is valuable for general practitioners and specialists alike to include NOVL in their differential when evaluating patients with visual complaints that are inconsistent with normal examination findings.

9.
Am J Ophthalmol ; 157(4): 774-780.e1, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24418264

RESUMO

PURPOSE: To report the clinical settings, antibiotic susceptibilities, and outcomes of endophthalmitis caused by Streptococcus species. DESIGN: Retrospective, observational case series. METHODS: Single-center study evaluating all patients with culture-positive endophthalmitis caused by Streptococcus species between January 1, 2000, and December 31, 2011. RESULTS: Study criteria were met by 63 patients. The most common clinical settings were bleb associated (n = 17; 27%), after intravitreal injection (n = 16; 25%), and after cataract surgery (n = 13; 21%). The isolates were Streptococcus viridans (n = 47; 71%), Streptococcus pneumoniae (n = 13; 21%), and ß-hemolytic Streptococci (n = 5; 8%). Sixty (95%) of 63 isolates were susceptible to vancomycin, 47 (98%) of 48 isolates were susceptible to ceftriaxone (third-generation cephalosporin), and 57 (93%) of 61 isolates were susceptible to levofloxacin (third-generation fluoroquinolone). Between the first and second half of the study, the minimal inhibitory concentration of antibiotics required to inhibit 90% of isolates increased by 1.5-fold for ceftriaxone and 2-fold for levofloxacin and remained the same for vancomycin. Initial treatment was vitreous tap (49; 78%) or pars plana vitrectomy (14; 22%); all received intravitreal antibiotics. Visual acuity outcomes were variable: best-corrected visual acuity was 20/400 or better in 16 (25%) patients and worse than 20/400 in 47 (75%) patients. Evisceration or enucleation was performed in 16 (25%) patients. CONCLUSIONS: Streptococcus isolates generally had high susceptibility rates to commonly used antibiotics. Higher antibiotic minimal inhibitory concentrations were required to inhibit 90% of isolates in vitro in the second half of the study period compared with the first half. Despite prompt treatment, most patients had poor outcomes.


Assuntos
Antibacterianos/uso terapêutico , Endoftalmite/microbiologia , Infecções Oculares Bacterianas/microbiologia , Infecções Estreptocócicas/microbiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Amicacina/uso terapêutico , Ceftazidima/uso terapêutico , Criança , Pré-Escolar , Terapia Combinada , Endoftalmite/diagnóstico , Endoftalmite/tratamento farmacológico , Infecções Oculares Bacterianas/diagnóstico , Infecções Oculares Bacterianas/tratamento farmacológico , Feminino , Humanos , Injeções Intravítreas , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Estudos Retrospectivos , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/tratamento farmacológico , Streptococcus/efeitos dos fármacos , Streptococcus/isolamento & purificação , Streptococcus pneumoniae/efeitos dos fármacos , Streptococcus pneumoniae/isolamento & purificação , Resultado do Tratamento , Vancomicina/uso terapêutico , Estreptococos Viridans/efeitos dos fármacos , Estreptococos Viridans/isolamento & purificação , Acuidade Visual , Vitrectomia , Adulto Jovem
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