Percutaneous Tracheostomy under Bronchoscopic Visualization Does Not Affect Short-Term or Long-Term Complications.

Percutaneous tracheostomy is a safe and effective bedside procedure. Some advocate the use of bronchoscopy during the procedure to reduce the rate of complications. We evaluated our complication rate in trauma patients undergoing percutaneous tracheostomy with and without bronchoscopic guidance to ascertain if there was a difference in the rate of complications. A retrospective review of all tracheostomies performed in critically ill trauma patients was performed using the trauma registry from an urban, Level I Trauma Center. Bronchoscopy assistance was used based on surgeon preference. Standard statistical methodology was used to determine if there was a difference in complication rates for procedures performed with and without the bronchoscope. From January 2007, to April 2016, 649 patients underwent modified percuteaneous tracheostomy; 289 with the aid of a bronchoscope and 360 without. There were no statistically significant differences in any type of complication regardless of utilization of a bronchoscope. The addition of bronchoscopy provides several theoretical benefits when performing percutaneous tracheostomy. Our findings, however, do not demonstrate a statistically significant difference in complications between procedures performed with and without a bronchoscope. Use of the bronchoscope should, therefore, be left to the discretion of the performing physician.

Neoadjuvant chemotherapy in the treatment of breast cancer.

Randomized prospective trials have demonstrated that patients with early-stage breast cancer preferring breast conservation can benefit from neoadjuvant chemotherapy, achieving about a 25% complete and greater than 80% partial pathologic response. These responses do not translate into a survival advantage. For earlier stage patients, neoadjuvant chemotherapy's primary advantage is the ability to increase the use of breast conservation. Patients who opt for neoadjuvant chemotherapy should have a clinical and radiographic assessment of the axilla. The inability to predict the extent and pattern of response to chemotherapy requires that surgeons monitor patient response during neoadjuvant chemotherapy to provide optimal surgical planning.