Extrapericardial Tamponade After Blunt Trauma.

Cardiac tamponade results from compression of the heart and great vessels. Mediastinal hematoma has been reported in association with cardiac tamponade in multiple settings, including nonaortic mediastinal hemorrhage from cervical spine fractures, aortic and carotid aneurysmal rupture, mediastinal penetrating trauma, and cardiac penetrating trauma. A few cases of blunt trauma to the anterior chest wall resulting in tamponade formation have been reported. We present a patient with an anterior mediastinal hematoma resulting from blunt chest trauma that caused extrapericardial cardiac tamponade due to bleeding from a branch of the left internal mammary artery after a motor vehicle collision.

Is Internal Mammary to the Anterior Descending Always the Best Option?

The left internal mammary artery (LIMA) is the gold standard conduit used to revascularize the left anterior descending artery and has consistently been shown to be associated with better survival, graft patency, and freedom from cardiac events compared with other used conduits. Evaluation of LIMA flow and anatomy is not routinely done by the interventional cardiologist while performing the left heart catheterization. We present a case where the LIMA was found to be the major blood supply to the left leg, which might have led to leg ischemia if the LIMA had been used as graft.

Video-Assisted Thoracoscopic versus Open Lobectomy: Costs and Outcomes.

OBJECTIVES: Video-assisted thoracoscopic (VATS) lobectomy is considered a promising surgical therapy for the diagnosis and treatment of non-small-cell lung carcinoma. The issue of whether VATS is superior to open thoracotomy remains controversial, however. We sought to determine whether the use of VATS lobectomy for diagnosing and treating non-small-cell lung carcinoma would improve patient outcomes at our institution. METHODS: A retrospective review of electronic and paper medical charts identified 109 consecutive operations for all patients undergoing thoracotomy or VATS lobectomy performed at the University of Kentucky Chandler Medical Center for fiscal years 2013 and 2014. Variables of interest included operative procedure (thoracotomy vs VATS) and operative findings (pathologic stage, operative time, postoperative length of stay [LOS], time spent in the intensive care unit, postoperative complications, direct cost). RESULTS: The demographic characteristics of the patients of both groups were similar in terms of sex (64.6% vs 44.3% male) and age (62.4 vs 61.6 years), but not stage, which was higher in the thoracotomy group. The overall operative procedure time (170.6 vs 196.3 minutes), postoperative LOS (5.7 vs 5.5 days), number of lymph nodes sampled (6.2 vs 7.0), and time spent in the intensive care unit (2.1 vs 2.4 days) did not vary between both groups. The average cost per procedure did not vary significantly-$14,003.61 compared with $15,588.11 for thoracotomy and VATS, respectively. CONCLUSIONS: In our study, the VATS group was associated with no reduction in postoperative LOS and a nonsignificant reduction in the amount of time spent in the intensive care unit. Postoperative perception of pain did not vary between either group. Pain perception did, however, correlate strongly with time from operation. Cost did not vary significantly between both groups, with VATS being equivalent to thoracotomy in terms of cost at our institution. In our experience, VATS is an effective, minimally invasive, and safe approach for the resection of lung nodules.

Variability in carotid endarterectomy at a single medical center: an outcome and cost analysis.

Carotid endarterectomy (CEA) is a common surgical procedure. Its efficacy in the prevention of stroke has been proven by multiple clinical trials including North American Symptomatic Carotid Endarterectomy Trial and Asymptomatic Carotid Atherosclerosis Study. Currently, there is a wide variability in the technique of this operation. This study was performed to determine the variability of CEA at the University of Kentucky Medical Center with a focus on cost and short-term outcome. We reviewed the charts of a consecutive series of 349 patients undergoing CEA at our institution. We analyzed the variability in shunt used across surgeons, intraoperative variables, cost, and outcome. Data on 374 procedures on 349 patients who underwent CEA showed shunt utilization varied significantly by surgeon from 3 to 94%. Patch utilization also varied significantly by surgeon. Two in-hospital deaths occurred in the shunt group (1.3%) and none in the no-shunt group. Shunt placement was associated with 1 hour 24 minutes increase in operative time from 2 hours 3 minutes in the no-shunt group to 3 hours 27 minutes in the shunt group (t test, p < 0.01). Shunt placement was associated with a 1.74-day increase in length of stay, from 2.97 days in the no-shunt group to 4.71 days in the shunt group. There was no significant difference in the cost of procedure in these two groups: no-shunt $11,510 ± $3,977, shunt group $11,479 ± $4,030. This study showed no significant difference in cost or outcome between various techniques.