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2.
J Vis Commun Med ; 40(1): 21-25, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28290710

RESUMO

Within surgery, interactive media have previously been used to educate medical students and residents. Here, we develop and assess the efficacy of a novel surgical video atlas in teaching surgically relevant head and neck anatomy to medical students. A total thyroidectomy was recorded intraoperatively and subsequently narrated to develop a video atlas. Medical students were recruited and randomly assigned to one of the two interventions. One group was assigned to the video atlas, while the other was supplied with a traditional textbook atlas. Both groups underwent pre- and post- tests to evaluate anatomical knowledge and satisfaction. Thirty-seven students completed the study, with 18 students in the experimental group and 19 students as control. In the video atlas arm, mean pre and post-test scores were 57.2% and 84.5%, respectively. In the traditional textbook arm, the mean pre- and post-test scores were 55.3% and 76.51%, respectively. Students with the video atlas had a mean post-test score 8.07% points higher than those without (p = .035). Overall, students were significantly more satisfied with the surgical video atlas than with the standard traditional textbook. A surgical video atlas was shown to more effectively teach head and neck anatomy to medical students compared to standard textbook atlases.


Assuntos
Cirurgia Geral/educação , Tireoidectomia , Gravação em Vídeo , Meios de Comunicação , Cabeça , Humanos , Estudantes de Medicina
3.
Cureus ; 15(10): e47582, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-38021934

RESUMO

The relationship between COVID-19 and sensorineural hearing loss (SNHL) continues to solidify in light of a growing body of evidence. In addition to the well-established COVID-19 symptoms and sequelae, otolaryngologists have observed an increased incidence of SNHL in patients with COVID-19 and following COVID-19 immunizations. Although the precise mechanisms behind this association remain unclear, various hypotheses are discussed within the scientific literature. This case report expands on the relationship between COVID-19 and SNHL by discussing a unique case of bilateral tinnitus and subsequent SNHL shortly following COVID-19 immunization. It contributes to the growing body of evidence associating COVID-19 with SNHL, underlining the importance of further research to understand potential causal mechanisms. It underscores the clinical importance of monitoring hearing in COVID-19 patients and those receiving immunizations, advocating for increased awareness among clinicians to facilitate early identification and appropriate intervention in cases of COVID-19-related hearing loss.

4.
Cureus ; 14(3): e23655, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35510011

RESUMO

Introduction Preventing errors in donning and doffing of personal protective equipment (PPE) is critical for limiting the spread of infectious diseases. Virtual reality (VR) has demonstrated itself as an effective tool for asynchronous learning, but its use in PPE training has not been tested. The objective of this study was to compare donning and doffing performance between VR and e-module PPE training. Methods A prospective randomized open-blinded controlled trial was conducted to determine differences in donning and doffing performance after VR and e-module PPE training among medical staff and medical students at a single institution. The primary outcome was donning and doffing performance with real PPE, assessed using a 64-point checklist. The secondary outcome was participant preparedness and confidence level after training.  Results Fifty-four participants were randomized, mostly consisting of medical students (n=24 {44%}) or emergency medicine and otolaryngology residents (n=19 {35%}). The VR group (n=27 {50%}) performed better than the control in the overall PPE scores but this was not statistically significant (mean {SD}, VR: 55.4 {4.4} vs e-module: 53.3 {8.1}; p = 0.40). VR participants also reported higher levels of preparedness and confidence after training. Residents as a subgroup achieved the highest increases after VR training compared to their counterparts in the control training group (mean {SD}, VR: 55.6 {4.9} vs e-module 48.4 {5.5}, p = 0.009).  Conclusion In this randomized trial, VR training was found to be non-inferior to e-module for asynchronous PPE training. Our results suggest that in particular residents may benefit most from VR PPE training. Additionally, VR participants felt more confident and prepared to don and doff PPE after training compared to e-module participants. These findings are particularly relevant given the ongoing coronavirus disease 2019 (COVID-19) pandemic. Future studies need to focus on VR integration into residency curriculum and monitoring for long-term skill retention.

5.
MedEdPublish (2016) ; 12: 47, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36168536

RESUMO

Background: To measure the impact of an intensive eight-week postgraduate year one (PGY-1) otolaryngology bootcamp on the acquisition and retention of otolaryngology residents' procedural skills compared to the traditional method of skill acquisition through clinical exposure. Methods: Residents at our institution were evaluated on their performance of flexible laryngoscopy, suture ligature, and rigid bronchoscopy setup at three time points: pre-bootcamp, one-week post-bootcamp, and one-year post-bootcamp. Video recordings were scored by two blinded faculty reviewers using a multipoint rating system. A control group of rising postgraduate year two (PGY-2) residents who did not participate in bootcamp were recorded performing these same skills. Scores in the three skills were compared between groups via t-tests. The eight-week bootcamp curriculum for PGY-1s was held at the Montefiore Einstein Center for Innovation in Simulation at Albert Einstein College of Medicine/Montefiore Medical Center. The participants were two classes of PGY-1 residents (n=8) at our institution who participated in a bootcamp at the beginning of residency, and one class of rising PGY-2 residents (n=3) who did not participate in a bootcamp (control group). Results: A comparison of pre-bootcamp scores to one-week post-bootcamp scores showed significant improvement in suture ligature ( P<0.05) and rigid bronchoscopy ( P<0.05), but no difference in flexible laryngoscopy ( P=0.54). Suture ligature ( P=0.09) and rigid bronchoscopy ( P=0.25) skills were not significantly different from one-week post-bootcamp to one-year post-bootcamp; however, a significant skill improvement was observed in flexible laryngoscopy ( P<0.05). By June of PGY1 year, the two bootcamp cohorts were similar to controls in all three skills: flexible laryngoscopy ( P=0.05), rigid bronchoscopy ( P=0.26), and suture ligature ( P=0.10). Conclusions: Participation in PGY-1 bootcamp was associated with improved acquisition and short-term retention of basic procedural skills, suggesting that bootcamps can be an effective arena to teach basic skills in otolaryngology. PGY-1 bootcamp is a promising arena for multi-institutional development.

6.
Cureus ; 13(6): e16072, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34345554

RESUMO

Pulmonary arteriovenous malformations (PAVM), also known as pulmonary arteriovenous fistulas, are abnormal connections between the pulmonary arterial and venous systems. The majority occur secondary to the congenital syndrome hereditary hemorrhagic telangiectasia (HHT), also known as Osler-Weber-Rendu disease. Trauma is an extremely rare etiology of PAVM, comprising less than 1% of all reported cases. Trauma can be associated with both immediate and delayed development of PAVM, and present similarly to PAVM associated with HHT. We report a case of a traumatic PAVM that developed in a patient one year following blunt thoracic trauma with a rib fracture. The patient subsequently developed a rupture of the PAVM, resulting in spontaneous hemothorax. She required multi-unit blood transfusion and multiple thoracostomy tube placements. The patient subsequently underwent a failed attempt at angioembolization of the PAVM. She eventually required a thoracotomy for surgical excision of the PAVM. We discuss the traumatic etiologies, clinical presentation, diagnostic assessments, and therapeutic modalities for the management of PAVM.

7.
J Allergy Clin Immunol Pract ; 7(5): 1580-1588, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30580047

RESUMO

BACKGROUND: Nasal polyps influence the burden of aspirin-exacerbated respiratory disease (AERD) by contributing to eicosanoid production. AERD is diagnosed through graded aspirin challenges. It is not known how sinus surgery affects aspirin challenge outcomes. OBJECTIVE: To investigate the effects of endoscopic sinus surgery (ESS) on aspirin-induced reaction severity and on the levels of eicosanoids associated with these reactions. METHODS: Twenty-eight patients with AERD were challenged with aspirin before and 3 to 4 weeks after ESS. Respiratory parameters and plasma and urine levels of eicosanoids were compared before and after challenges. RESULTS: Before ESS, AERD diagnosis was confirmed in all study patients by aspirin challenges that resulted in hypersensitivity reactions. After ESS, reactions to aspirin were less severe in all patients and 12 of 28 patients (43%, P < .001) had no detectable reaction. A lack of clinical reaction to aspirin was associated with lower peripheral blood eosinophilia (0.1 K/µL [interquartile range (IQR) 0.1-0.3] vs 0.4 K/µL [IQR 0.2-0.8]; P = .006), lower urinary leukotriene E4 levels after aspirin challenge (98 pg/mg creatinine [IQR 61-239] vs 459 pg/mg creatinine [IQR 141-1344]; P = .02), and lower plasma prostaglandin D2 to prostaglandin E2 ratio (0 [±0] vs 0.43 [±0.2]; P = .03), compared with those who reacted. CONCLUSIONS: Sinus surgery results in decreased aspirin sensitivity and a decrease in several plasma and urine eicosanoid levels in patients with AERD. Diagnostic aspirin challenges should be offered to patients with suspected AERD before ESS to increase diagnostic accuracy. Patients with established AERD could undergo aspirin desensitizations after ESS as the severity of their aspirin-induced hypersensitivity reactions lessens.


Assuntos
Asma Induzida por Aspirina , Endoscopia , Procedimentos Cirúrgicos Nasais , Adulto , Aspirina/efeitos adversos , Asma Induzida por Aspirina/sangue , Asma Induzida por Aspirina/metabolismo , Asma Induzida por Aspirina/fisiopatologia , Asma Induzida por Aspirina/urina , Eicosanoides/sangue , Eicosanoides/urina , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Pessoa de Meia-Idade , Óxido Nítrico/metabolismo , Seios Paranasais , Índice de Gravidade de Doença
8.
J Robot Surg ; 12(4): 617-623, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29417393

RESUMO

Transoral robotic surgery (TORS) is becoming an integral part of the otolaryngology resident experience. While there is widespread agreement that a formal, validated curriculum for TORS training is needed for residents, none presently exists. The primary objective of this study is to evaluate an introductory resident curriculum for TORS training that could be easily adopted at other institutions. This is a prospective study of otolaryngology residents (PGY1-5) in an academic medical center from 2015 to 2016. Trainees completed an introductory TORS training program consisting of online modules, logistic training, and hands-on training consisting of 12 tasks on the da Vinci Skills Simulator (dVSS). The primary outcomes were completion of training and time to completion. The secondary outcomes included resident attitudes regarding TORS as reflected on post-training survey. A total of 20 resident trainees participated in the study. 85% of trainees completed the hands-on robotic training in the allotted 3-h time limit. The average time to completion for those who finished was 91.53 min (SD 33.59 min). There was no statistically significant correlation between time to completion and PGY, number of robotic first assists, or total number of robotic cases. An introductory, resident-directed TORS training curriculum using the dVSS on an active surgical console is feasible in an academic medical center and may contribute to basic robotic competency among residents. Institutions with a dVSS may replicate this training in a resource-efficient manner prior to implementation of more comprehensive training. Robotic skills are likely trainable and independent from surgical skills learned during residency.


Assuntos
Currículo , Internato e Residência , Otolaringologia/educação , Procedimentos Cirúrgicos Robóticos/educação , Competência Clínica , Hospitais Universitários , Humanos , New York , Avaliação de Programas e Projetos de Saúde , Estudos Prospectivos
9.
Laryngoscope ; 127(7): E219-E224, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-27782300

RESUMO

OBJECTIVES/HYPOTHESIS: E-learning, in its most rudimentary form, is the use of Internet-based resources for teaching and learning purposes. In surgical specialties, this definition encompasses the use of virtual patient cases, digital modeling, and online tutorials, as well as standardized video and imaging. As new technological frontiers rapidly emerge within otolaryngology, e-learning may be an effective alternative to traditional teaching. Here we present a systematic review of the literature assessing the efficacy of e-learning for otolaryngology education and a discussion of the relevance of these programs for both medical students and residents within the field. STUDY DESIGN: Systematic review. METHODS: A systematic search of PubMed, Embase, Web of Science, and the Cochrane Library was conducted according to the guidelines defined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. RESULTS: Twelve studies met inclusion criteria. These studies measured a range of outcomes from basic science anatomical knowledge to clinically relevant endpoints such as diagnostic accuracy. Nearly all of the studies reported greater satisfaction and/or significantly increased objective knowledge using the e-learning intervention compared to traditional techniques. CONCLUSIONS: E-learning proves to be a powerful alternative to standard teaching techniques within otolaryngology education for both residents and medical students. Future work should focus on validating specific e-learning programs and accessing long-term knowledge retention using these innovative platforms. LEVEL OF EVIDENCE: NA Laryngoscope, 127:E219-E224, 2017.


Assuntos
Instrução por Computador , Educação Médica , Internet , Internato e Residência , Otolaringologia/educação , Atitude do Pessoal de Saúde , Currículo , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Interface Usuário-Computador
10.
Otolaryngol Clin North Am ; 50(5): 893-901, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28822578

RESUMO

The convergence of technology and medicine has led to many advances in surgical training. Novel surgical simulators have led to significantly improved skills of graduating surgeons, leading to decreased time to proficiency, improved efficiency, decreased errors, and improvement in patient safety. Endoscopic sinus surgery poses a steep learning curve given the complex 3-dimensional anatomy of the nasal and paranasal cavities, and the necessary visual-spatial motor skills and bimanual dexterity. This article focuses on surgical simulation in rhinological training and how innovative high-fidelity and low-fidelity simulators can maximize resident training and improve procedural skills before operating in the live environment.


Assuntos
Simulação por Computador , Endoscopia/educação , Otolaringologia/educação , Seios Paranasais/cirurgia , Treinamento por Simulação , Competência Clínica , Humanos , Internato e Residência , Software
11.
J Allergy Clin Immunol Pract ; 5(4): 998-1007.e2, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28159558

RESUMO

BACKGROUND: Aspirin desensitization followed by daily aspirin provides therapeutic benefits to patients with aspirin-exacerbated respiratory disease (AERD). It is not well understood how eicosanoid levels change during aspirin treatment. OBJECTIVE: To investigate associations between clinical outcomes of aspirin treatment and plasma eicosanoid levels in patients with AERD. METHODS: Thirty-nine patients with AERD were offered aspirin treatment (650 mg twice daily) for 4 weeks. Respiratory parameters and plasma levels of multiple eicosanoids were recorded at baseline and after 4 weeks of aspirin therapy using the Asthma Control Test and Rhinoconjunctivitis Quality of Life Questionnaire. Respiratory function was evaluated using the FEV1 and nasal inspiratory peak flow. RESULTS: After aspirin treatment, respiratory symptoms improved in 16 patients, worsened in 12 patients, and did not change in 4 patients. Seven patients were unable to complete the desensitization protocol. Patients with symptom improvement had higher baseline plasma 15-hydroxyeicosatetraenoic acid (15-HETE) levels than did patients with symptom worsening: 7006 pg/mL (interquartile range, 6056-8688 pg/mL) versus 4800 pg/mL (interquartile range, 4238-5575 pg/mL), P = .0005. Baseline 15-HETE plasma levels positively correlated with the change in Asthma Control Test score (r = 0.61; P = .001) and in FEV1 after 4 weeks of aspirin treatment (r = 0.49; P = .01). It inversely correlated with Rhinoconjunctivitis Quality of Life Questionnaire score (r = -0.58; P = .002). Black and Latino patients were more likely to have symptom worsening on aspirin or fail to complete the initial desensitization than white, non-Latino patients (P = .02). CONCLUSIONS: In patients with AERD, low baseline 15-HETE plasma levels and black or Latino ethnicity are associated with worsening of respiratory symptoms during aspirin treatment.


Assuntos
Aspirina/uso terapêutico , Asma Induzida por Aspirina/sangue , Asma Induzida por Aspirina/terapia , Inibidores de Ciclo-Oxigenase/uso terapêutico , Dessensibilização Imunológica , Ácidos Hidroxieicosatetraenoicos/sangue , Adulto , Asma Induzida por Aspirina/etnologia , Asma Induzida por Aspirina/fisiopatologia , População Negra , Feminino , Volume Expiratório Forçado , Hispânico ou Latino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
12.
J Orthop Trauma ; 20(4): 273-6, 2006 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-16721243

RESUMO

PURPOSE: To compare the relative strength and stability of 2 fixation methods for displaced coronal shear fractures of the lateral femoral condyle (Hoffa fractures, OTA Type 33B3). SETTING: University Biomechanics laboratory. DESIGN: Eight matched pairs of embalmed femurs were divided into 2 groups and simulated Hoffa fractures were created. In each pair, 1 of the fractures was fixed with 2 screws placed in an anteroposterior direction, and in the other, the fracture was fixed with 2 screws placed in a posteroanterior direction. METHODS: All specimens were cyclically tested with simulated physiologic loading. Displacement of the femoral condyle was continuously measured to 10 cycles. The specimens were then loaded to failure. RESULTS: Fixation with posterior to anteriorly placed cancellous lag screws was significantly more stable than that with anterior to posteriorly placed screws at 10 cycles (P = 0.05), with 0.67 mm displacement compared to 1.36 mm, respectively. They were also more stable at 10, 100, and 1000 cycles; however, these displacements were not statistically significant. Fixation with posteriorly placed cancellous screws also had significantly higher ultimate strength (P = 0.04), 1700 N compared to 1025 N for anterior placement. CONCLUSION AND SIGNIFICANCE: Lag screws placed posterior to anterior provided more stable fixation of Hoffa fractures in embalmed femurs than anteroposteriorly placed lag screws. This finding may apply in the clinical setting; however, this technique requires that the screw heads be recessed beneath the articular surface. The effects of the cartilage defects so created are not known. The choice of technique is also determined by concomitant fractures and the exposure required for their fixation.


Assuntos
Fenômenos Biomecânicos/métodos , Parafusos Ósseos , Análise de Falha de Equipamento/métodos , Fraturas do Fêmur/fisiopatologia , Fraturas do Fêmur/cirurgia , Fixação Interna de Fraturas/instrumentação , Idoso , Elasticidade , Feminino , Humanos , Técnicas In Vitro , Masculino , Pessoa de Meia-Idade , Movimento (Física) , Estresse Mecânico , Resultado do Tratamento
13.
JACC Heart Fail ; 4(12): 962-970, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27744088

RESUMO

OBJECTIVES: This study sought to determine whether the nasal mucosa can serve as a surrogate for evaluating arteriovenous malformations (AVMs) related gastrointestinal (GI) bleeding in patients supported by continuous-flow left ventricular assist devices (CF LVADs). BACKGROUND: Bleeding from the mucosal surfaces of GI tract, particularly AVMs, is the most common complication of CF LVAD support. The pathophysiology of AVM formation during CF LVAD support is of critical interest yet poorly understood; in large part because of the length and accessibility of the GI tract. Nasal endoscopy is a minimally invasive, bedside test giving access to a mucosal surface possibly representative of the GI tract. METHODS: Eighty subjects (35 with CF LVAD, 30 with heart failure reduced ejection fraction [HFrEF], and 15 controls without heart failure) underwent nasal endoscopy for systematic evaluation of the intranasal mucosa for the presence of hypervascularity (HV). Patient records were reviewed for episodes and etiology of GI bleeding. RESULTS: Nasal HV was present in 63%, 57%, and 20% of the LVAD, HFrEF, and control groups, respectively (p = 0.018). Although the prevalence was similar, the severity of nasal HV was significantly higher in the CF LVAD group compared with the HFrEF group. Of the baseline characteristics in the entire cohort, only a history of heart failure was associated with HV (odds ratio: 4.8; 95% confidence interval: 1.02 to 22.31; p = 0.040) in adjusted logistic regression modeling. HV was strongly associated with GI bleeding in the CF LVAD cohort: the incidence was 32% in subjects with HV compared with 0% in subjects with normal mucosa (p = 0.023). CONCLUSIONS: In this pilot study, HV of the nasal mucosa was associated with GI bleeding in subjects with CF LVADs. Nasal endoscopy has significant potential to further investigation into mechanisms of bleeding and risk stratification during CF LVAD support.


Assuntos
Malformações Arteriovenosas/epidemiologia , Hemorragia Gastrointestinal/epidemiologia , Trato Gastrointestinal/irrigação sanguínea , Insuficiência Cardíaca/terapia , Coração Auxiliar , Mucosa Nasal/irrigação sanguínea , Adulto , Idoso , Malformações Arteriovenosas/diagnóstico por imagem , Estudos de Casos e Controles , Endoscopia , Feminino , Insuficiência Cardíaca/fisiopatologia , Humanos , Incidência , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Projetos Piloto , Prevalência , Volume Sistólico , Estados Unidos/epidemiologia
14.
Otolaryngol Head Neck Surg ; 153(6): 903-4, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26519458

RESUMO

Variation, long accepted to be the norm in otolaryngologic surgical practice, has recently come under scrutinization. Efforts can be seen daily in the operating room to standardize procedures with time-outs, checklists, and protocols. The thought is that by enforcing repetition and eliminating variation, it is possible to decrease human error and reduce cost. However, there is understandable resistance from surgeons in removing the "art" from surgery. We propose that standardization, if appropriately put into practice, can improve surgical outcomes and efficiency and even enhance resident education.


Assuntos
Procedimentos Cirúrgicos Operatórios/normas
15.
Ann Thorac Surg ; 99(2): 704-7, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25639416

RESUMO

We present a case of a woman with acute respiratory distress syndrome and irrecoverable lung function that was successfully bridged to lung transplantation after 155 consecutive days of venovenous extracorporeal membrane oxygenation.


Assuntos
Oxigenação por Membrana Extracorpórea/métodos , Transplante de Pulmão , Feminino , Humanos , Fatores de Tempo , Veias , Adulto Jovem
16.
Head Neck ; 37(8): 1200-6, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24800735

RESUMO

BACKGROUND: Review patient and defect factors in which this donor site is an optimal choice for reconstruction and to discuss strategies to overcome the perceived drawbacks of this system of flaps. METHODS: A retrospective medical chart review was conducted on all patients who underwent the subscapular system of free flaps for head and neck reconstruction. RESULTS: Ninety-eight reconstructions were performed for mandibular defects, 4 for maxillary defects alone and 3 for combined mandible-maxilla defects. The overall success rate was 98%. CONCLUSION: The subscapular system of free flaps is an excellent option in patients for whom the alternative donor sites are either not usable or lack the associated soft tissue elements required for a successful reconstruction. This flap should also be considered as a first choice for patients with complex/extensive surgical defects requiring multiple, independently mobile, soft tissue components; in patients who will benefit from a large muscle flap placed over the vital structures in the neck; patients of advanced age; and patients in whom early mobilization is critical.


Assuntos
Transplante Ósseo , Retalhos de Tecido Biológico/transplante , Neoplasias Mandibulares/cirurgia , Neoplasias Maxilares/cirurgia , Procedimentos de Cirurgia Plástica , Escápula/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Transplante Ósseo/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos de Cirurgia Plástica/métodos , Estudos Retrospectivos , Resultado do Tratamento
17.
Innovations (Phila) ; 9(6): 448-50, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25438110

RESUMO

Preoperative colostomy presents a significant risk of sternal wound complications, mediastinitis, and ostomy injury in patients requiring coronary artery bypass grafting. Less invasive procedures in coronary surgery have a potential to reduce the risk of sternal wound healing problems. Robotic totally endoscopic coronary artery bypass grafting in patients with a colostomy has not been reported. We describe a case of completely endoscopic coronary surgery using the da Vinci Si system in a patient with a transverse colostomy. Single left internal mammary artery grafting to the left anterior coronary artery was performed successfully on the beating heart. We regard this technique as the least invasive method of surgical coronary revascularization with a potential to reduce the risk of surgical site infection and mediastinitis in patients with a colostomy.


Assuntos
Colostomia , Ponte de Artéria Coronária/métodos , Endoscopia/métodos , Robótica/métodos , Ponte Cardiopulmonar , Humanos , Masculino , Mediastinite/prevenção & controle , Pessoa de Meia-Idade , Infecção da Ferida Cirúrgica/prevenção & controle
18.
Ann Thorac Surg ; 98(1): 327-9, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24996716

RESUMO

A 64-year-old male with end-stage lung disease underwent right orthotopic lung transplantation. After doing well initially, he developed acute hypoxemic respiratory failure with allograft pneumonia. Donor operative cultures demonstrated mold of the Mucor species, which were corroborated by donor endobronchial cultures obtained near the right mainstem bronchial anastomosis. The patient was treated with reoperative bilateral orthotopic lung transplantation in combination with antifungal agents. The operation was performed successfully, using lungs donated after cardiac death and treated with ex vivo lung perfusion. The patient has recovered well, remaining on room air with good allograft function, without evidence of fungal disease.


Assuntos
Pneumopatias Fúngicas/cirurgia , Transplante de Pulmão , Mucormicose/cirurgia , Insuficiência Respiratória/cirurgia , Infecção da Ferida Cirúrgica/cirurgia , Doadores de Tecidos , Humanos , Masculino , Pessoa de Meia-Idade , Reoperação
19.
Ann Thorac Surg ; 96(5): 1643-7, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-23987901

RESUMO

BACKGROUND: According to several studies, women are at higher risk for mortality and experience less relief of angina after coronary artery bypass graft surgery (CABG) than men. Sex-related differences in patients undergoing totally endoscopic coronary bypass grafting (TECABG) have not been investigated thus far. The aim of the present study was to evaluate the impact of sex on the outcome of patients undergoing TECABG. METHODS: The data of 500 consecutive patients (364 male, 136 female) undergoing TECABG using the da Vinci telemanipulation system (Intuitive Surgical, Sunnyvale, CA) from 2001 to 2011 at two institutions were investigated regarding sex-related differences in short-term and long-term outcome. RESULTS: In all, 334 single, 150 double, 15 triple, and 1 quadruple TECABG procedures were carried out. Female patients were significantly older (63 years [range, 26 to 90] versus 59 years [range, 31 to 85], p = 0.001) and had higher European System for Cardiac Operative Risk Evaluation score levels (3 [range, 0 to 11] versus 2 [range, 0 to 13], p < 0.001). Male patients received slightly more grafts (1 [range, 1 to 4] versus 1 [range, 1 to 3], p = 0.028), female patients were more likely to undergo beating heart surgery (20% versus 28%, p = 0.042). In-hospital mortality was 3 of 364 men (0.8%) and 2 of 136 women (1.5%; p = 0.513). Comparison of long-term-survival revealed 1-, 3- and 5-year survival rates of 96%, 96%, and 95% in men and 96%, 96%, and 96% in women, respectively, without any significant difference. Analysis of freedom from major adverse cardiac and cerebrovascular events revealed 1-, 3-, and 5-year rates of 86%, 84%, and 82% in men and 85%, 81%, and 81% in women, respectively, without any significant difference. CONCLUSIONS: Our data show that women undergoing TECABG have outcomes similar to those of men.


Assuntos
Ponte de Artéria Coronária/métodos , Endoscopia , Robótica , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores Sexuais , Resultado do Tratamento
20.
Laryngoscope ; 122(4): 790-2, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22302608

RESUMO

Vagal nerve schwannomas are rare, benign, neural sheath tumors. The treatment of enlarging or symptomatic vagal nerve schwannomas is surgical resection. Transecting the vagus nerve results in significant morbidity, and attempts at nerve preservation should be made whenever possible. We introduce a nerve-sparing technique using meticulous microsurgical dissection and intraoperative nerve monitoring for vagal schwannomas. A 61-year old patient presented with an enlarging 2-cm right vagal nerve schwannoma. She underwent resection via a transcervical approach. The patient was intubated with an electromyographic (EMG) endotracheal tube that allowed for monitoring of the recurrent laryngeal nerve intraoperatively. A microsurgical subcapsular dissection was performed after branches of the vagus nerve were identified using a nerve probe and preserved. At the conclusion of the resection the nerve was intact and stimulated along its entire course. Postoperatively, the patient had normal vagal nerve function. We introduced the role of intraoperative nerve monitoring using an EMG endotracheal tube for successful enucleation of vagal schwannomas. In conjunction with meticulous microsurgical dissection, nerve monitoring allows for successful preservation of the vagus nerve and decreased postoperative morbidity.


Assuntos
Neoplasias dos Nervos Cranianos/cirurgia , Microcirurgia/métodos , Monitorização Intraoperatória/métodos , Neurilemoma/cirurgia , Nervo Laríngeo Recorrente/fisiopatologia , Doenças do Nervo Vago/cirurgia , Nervo Vago , Neoplasias dos Nervos Cranianos/diagnóstico , Neoplasias dos Nervos Cranianos/fisiopatologia , Eletromiografia/métodos , Feminino , Seguimentos , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Neurilemoma/diagnóstico , Neurilemoma/fisiopatologia , Doenças do Nervo Vago/diagnóstico , Doenças do Nervo Vago/fisiopatologia
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