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[PMID]:29223276
[Au] Autor:Dhakal A; Chen H; Dexter EU
[Ad] Endereço:Department of Medicine, Roswell Park Cancer Institute and Department of Medicine, University at Buffalo, Buffalo, NY. Electronic address: ajaydhakal@hotmail.com.
[Ti] Título:A 51-Year-Old Woman With an Increasing Chest Wall Mass Years After Resection of an Early Stage Lung Cancer.
[So] Source:Chest;152(6):e151-e154, 2017 12.
[Is] ISSN:1931-3543
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:CASE PRESENTATION: A 51-year-old woman was found to have a new 14 × 6 mm soft tissue mass under the right serratus muscle on a CT scan of the chest performed for routine surveillance due to her history of stage I lung cancer. A follow-up CT scan performed 4 months later showed that the mass had increased in size to 22 × 8 mm. The patient presents to the oncology clinic to discuss the results of the CT scan. She has no pain or swelling on the right lateral chest and no cough, fever, or shortness of breath. She is at her baseline health with good appetite and functional status.
[Mh] Termos MeSH primário: Adenocarcinoma/cirurgia
Biópsia por Agulha/efeitos adversos
Neoplasias Pulmonares/cirurgia
Recidiva Local de Neoplasia/etiologia
Estadiamento de Neoplasias
Pneumonectomia/métodos
Parede Torácica/diagnóstico por imagem
[Mh] Termos MeSH secundário: Adenocarcinoma/diagnóstico
Diagnóstico Diferencial
Progressão da Doença
Feminino
Seguimentos
Seres Humanos
Biópsia Guiada por Imagem
Neoplasias Pulmonares/diagnóstico
Mediastinoscopia
Meia-Idade
Recidiva Local de Neoplasia/diagnóstico
Inoculação de Neoplasia
Tomografia Computadorizada com Tomografia por Emissão de Pósitrons
Fatores de Tempo
Tomografia Computadorizada por Raios X
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171211
[St] Status:MEDLINE


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[PMID]:29480824
[Au] Autor:Zhang B; Ma J; Yan X; Li X; Xiao Q; Wang W; Zhou Y
[Ad] Endereço:The 2nd Department of Thoracic Surgery.
[Ti] Título:Left minimally invasive esophagectomy in a patient with synchronous esophageal and lung cancers: Case report.
[So] Source:Medicine (Baltimore);97(2):e9173, 2018 Jan.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Minimally invasive esophagectomy (MIE) have been increasingly used and are regarded as suitable alternatives to open esophagectomy. However, few previous reports described minimally invasive esophagectomy using a left-sided approach. PATIENT CONCERNS AND DIAGNOSES: A 71-year-old man was admitted to our hospital because of progressive dysphagia. Synchronous double primary thoracic esophageal and left lung cancers were considered before the operation. INTERVENTIONS AND OUTCOMES: A lobectomy and MIE, via a left video-assisted thoracoscopic approach, was performed. Preparation of a gastric conduit and an intra-abdominal lymphadenectomy were completed by laparoscopy and a cervical anastomosis was made. In addition, a cervical mediastinoscopy was performed to dissect the lymph nodes along the bilateral recurrent laryngeal nerves. No postoperative complications were observed. The patient achieved a favorable short-term outcome. LESSONS: This is the first report of a patient with synchronous esophageal and left lung cancers treated with minimally invasive resection via left thoracoscopy, laparoscopy, and cervical mediastinoscopy. Our results showed that the left MIE approach in combination with cervical mediastinoscopy is potentially most appropriate for some esophageal cancer patients, when the right MIE approach is not applicable in certain conditions.
[Mh] Termos MeSH primário: Neoplasias Esofágicas/cirurgia
Esofagectomia
Neoplasias Pulmonares/cirurgia
Procedimentos Cirúrgicos Minimamente Invasivos
[Mh] Termos MeSH secundário: Idoso
Neoplasias Esofágicas/complicações
Neoplasias Esofágicas/diagnóstico por imagem
Esofagectomia/métodos
Seres Humanos
Laparoscopia/métodos
Neoplasias Pulmonares/complicações
Neoplasias Pulmonares/diagnóstico por imagem
Masculino
Mediastinoscopia/métodos
Procedimentos Cirúrgicos Minimamente Invasivos/métodos
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180302
[Lr] Data última revisão:
180302
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180227
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009173


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[PMID]:28684006
[Au] Autor:Faris NR; Smeltzer MP; Lu F; Fehnel CL; Chakraborty N; Houston-Harris CL; Robbins ET; Signore RS; McHugh LM; Wolf BA; Wiggins L; Levy P; Sachdev V; Osarogiagbon RU
[Ad] Endereço:Thoracic Oncology Research Group, Baptist Cancer Center, Memphis, Tennessee.
[Ti] Título:Evolution in the Surgical Care of Patients With Non-Small Cell Lung Cancer in the Mid-South Quality of Surgical Resection Cohort.
[So] Source:Semin Thorac Cardiovasc Surg;29(1):91-101, 2017 Spring.
[Is] ISSN:1532-9488
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Surgery is the most important curative treatment modality for patients with early-stage non-small cell lung cancer (NSCLC). We examined the pattern of surgical resection for NSCLC in a high incidence and mortality region of the United States over a 10-year period (2004-2013) in the context of a regional surgical quality improvement initiative. We abstracted patient-level data on all resections at 11 hospitals in 4 contiguous Dartmouth Hospital Referral Regions in North Mississippi, East Arkansas, and West Tennessee. Surgical quality measures focused on intraoperative practice, with emphasis on pathologic nodal staging. We used descriptive statistics and trend analyses to assess changes in practice over time. To measure the effect of an ongoing regional quality improvement intervention with a lymph node specimen collection kit, we used period effect analysis to compare trends between the preintervention and postintervention periods. Of 2566 patients, 18% had no preoperative biopsy, only 15% had a preoperative invasive staging test, and 11% underwent mediastinoscopy. The rate of resections with no mediastinal lymph nodes examined decreased from 48%-32% (P < 0.0001), whereas the rate of resections examining 3 or more mediastinal stations increased from 5%-49% (P < 0.0001). There was a significant period effect in the increase in the number of N1, mediastinal, and total lymph nodes examined (all P < 0.0001). A quality improvement intervention including a lymph node specimen collection kit shows early signs of having a significant positive effect on pathologic nodal examination in this population-based cohort. However, gaps in surgical quality remain.
[Mh] Termos MeSH primário: Carcinoma Pulmonar de Células não Pequenas/cirurgia
Neoplasias Pulmonares/cirurgia
Excisão de Linfonodo/tendências
Mediastinoscopia/tendências
Pneumonectomia/tendências
Padrões de Prática Médica/tendências
Avaliação de Processos (Cuidados de Saúde)/tendências
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Arkansas
Biópsia/tendências
Carcinoma Pulmonar de Células não Pequenas/mortalidade
Carcinoma Pulmonar de Células não Pequenas/secundário
Feminino
Pesquisas sobre Serviços de Saúde
Disparidades em Assistência à Saúde/tendências
Seres Humanos
Neoplasias Pulmonares/mortalidade
Neoplasias Pulmonares/patologia
Excisão de Linfonodo/efeitos adversos
Excisão de Linfonodo/mortalidade
Metástase Linfática
Masculino
Mediastinoscopia/efeitos adversos
Mediastinoscopia/mortalidade
Meia-Idade
Mississippi
Estadiamento de Neoplasias
Pneumonectomia/efeitos adversos
Pneumonectomia/mortalidade
Valor Preditivo dos Testes
Melhoria de Qualidade/tendências
Indicadores de Qualidade em Assistência à Saúde/tendências
Estudos Retrospectivos
Tennessee
Fatores de Tempo
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170911
[Lr] Data última revisão:
170911
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170708
[St] Status:MEDLINE


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[PMID]:28528064
[Au] Autor:Velez-Cubian FO; Toosi K; Glover J; Pancholy B; Hong E
[Ad] Endereço:Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida.
[Ti] Título:Transient Aphonia After Mediastinoscopy.
[So] Source:Ann Thorac Surg;103(6):e549-e550, 2017 Jun.
[Is] ISSN:1552-6259
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:The most common adverse event after cervical mediastinoscopy is recurrent laryngeal nerve (RLN) injury, which has an incidence of 0.6% [1]. We report the case of a 68-year-old man with non-small cell lung cancer (NSCLC) who experienced transient bilateral vocal cord paralysis after mediastinoscopy, which manifested in complete aphonia. This patient's ability to maintain his airway was carefully followed up, but neither endotracheal intubation nor tracheostomy was required. The vocal cord paralysis resolved without intervention after 5 hours. To our knowledge, this is the first reported case in which bupivicaine used at the end of a cervical mediastinoscopy diffused through the freshly dissected planes to paralyze both RLNs along the tracheoesophageal grooves.
[Mh] Termos MeSH primário: Afonia/etiologia
Mediastinoscopia/efeitos adversos
Paralisia das Pregas Vocais/etiologia
[Mh] Termos MeSH secundário: Idoso
Carcinoma Pulmonar de Células não Pequenas/diagnóstico
Seres Humanos
Neoplasias Pulmonares/diagnóstico
Masculino
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170815
[Lr] Data última revisão:
170815
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170522
[St] Status:MEDLINE


  5 / 1510 MEDLINE  
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[PMID]:28431713
[Au] Autor:Buchanan SN; Radecki KM; Chambers LW
[Ad] Endereço:Department of Surgery, Mount Carmel West Hospital, Mount Carmel Health System, Columbus, Ohio. Electronic address: sbuchanan@mchs.com.
[Ti] Título:Mediastinal Paraganglioma.
[So] Source:Ann Thorac Surg;103(5):e413-e414, 2017 May.
[Is] ISSN:1552-6259
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:Paragangliomas of the mediastinum are rare, with only approximately 150 cases reported in the literature. Surgical excision is the treatment of choice; however, these tumors often lie near critical vascular structures. Here we present the case of a patient with a mediastinal paraganglioma discovered during a diagnostic procedure.
[Mh] Termos MeSH primário: Neoplasias do Mediastino/diagnóstico
Paraganglioma Extrassuprarrenal/diagnóstico
[Mh] Termos MeSH secundário: Idoso
Biópsia
Feminino
Seres Humanos
Neoplasias do Mediastino/cirurgia
Mediastinoscopia
Paraganglioma Extrassuprarrenal/cirurgia
Tomografia Computadorizada por Raios X
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170810
[Lr] Data última revisão:
170810
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170423
[St] Status:MEDLINE


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[PMID]:28187791
[Au] Autor:Pallangyo P; Nicholaus P; Lyimo F; Urio E; Kisenge P; Janabi M
[Ad] Endereço:Department of Cardiovascular Medicine, Jakaya Kikwete Cardiac Institute, P.O. Box 65141, Dar es Salaam, Tanzania. pedro.pallangyo@gmail.com.
[Ti] Título:Primary mediastinal large B cell lymphoma in a woman who is human immunodeficiency virus positive presenting with superior vena cava syndrome: a case report.
[So] Source:J Med Case Rep;11(1):38, 2017 Feb 11.
[Is] ISSN:1752-1947
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The risk of non-Hodgkin lymphoma is increased 200-fold in individuals seropositive for human immunodeficiency virus compared to those free from human immunodeficiency virus. Human immunodeficiency virus-associated non-Hodgkin lymphoma is known for its atypical presentation, aggressive ability, widespread involvement, poor response to chemotherapy, and high relapse potential which makes both the diagnosis and management a difficult undertaking especially in resource-poor settings. CASE PRESENTATION: We report a case of primary mediastinal large B cell lymphoma in a 46-year-old woman of African descent who is human immunodeficiency virus positive who presented with symptoms of superior vena cava syndrome. Her past medical history was remarkable for a 23-year history of systemic hypertension and a 10-year history of human immunodeficiency virus infection. A physical examination revealed an underweight woman with right-sided facial, neck, upper limb, and trunk swelling together with distended veins on her chest and abdomen draining downwards. A respiratory examination revealed a reduced chest expansion, stony dull percussion note, and absent breath sounds on her entire right side with a left-sided tracheal deviation. She had a CD4 count of 146 cells/µL. A chest X-ray revealed a homogenous opacification on her right side with a left-sided tracheal deviation while a computed tomography scan of her chest revealed a solid mass on her right side. An echocardiogram showed a huge well-circumscribed mass (4.6×3.3 cm) with spontaneous echocardiographic contrast compressing her heart inferiorly. She had severe pulmonary hypertension (right ventricular systolic pressure 58 mmHg) but preserved left ventricular systolic function, no thrombus was seen, and her pericardium was normal. A computed tomography angiography of her aorta ruled out an aortic aneurysm. Finally, she underwent mediastinoscopy and a direct biopsy of the mass was taken for histopathology. Hematoxylin and eosin staining demonstrated a dense lymphoid infiltrate of large malignant cells with pleomorphic nuclei in clusters, compartmentalized by fine bands of fibrosis, and frequent mitoses were present. A diagnosis of mediastinal large B cell lymphoma was reached. CONCLUSIONS: The presence of a mediastinal widening coupled with a history of unintentional yet significant weight loss in an individual who is human immunodeficiency virus seropositive should raise an index of suspicion for lymphomas and warrant aggressive investigations and timely management.
[Mh] Termos MeSH primário: Infecções por HIV/complicações
Soropositividade para HIV/complicações
Linfoma Difuso de Grandes Células B/etiologia
[Mh] Termos MeSH secundário: Angiografia por Tomografia Computadorizada
Evolução Fatal
Feminino
Seres Humanos
Linfoma Difuso de Grandes Células B/diagnóstico
Mediastinoscopia
Meia-Idade
Radiografia
Síndrome da Veia Cava Superior/diagnóstico por imagem
Tomografia Computadorizada por Raios X
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170720
[Lr] Data última revisão:
170720
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170212
[St] Status:MEDLINE
[do] DOI:10.1186/s13256-017-1200-z


  7 / 1510 MEDLINE  
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[PMID]:27623273
[Au] Autor:Kamel MK; Rahouma M; Ghaly G; Nasar A; Port JL; Stiles BM; Nguyen AB; Altorki NK; Lee PC
[Ad] Endereço:Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Weill Cornell Medicine-New York Presbyterian Hospital, New York, New York.
[Ti] Título:Clinical Predictors of Persistent Mediastinal Nodal Disease After Induction Therapy for Stage IIIA N2 Non-Small Cell Lung Cancer.
[So] Source:Ann Thorac Surg;103(1):281-286, 2017 Jan.
[Is] ISSN:1552-6259
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Patients with persistent N2 disease after induction have poor survival. Many of these patients may have had mediastinoscopy before induction therapy, making reassessment of the mediastinum by repeat mediastinoscopy hazardous and inaccurate. The sensitivity and specificity of endobronchial ultrasonography and nodal fine-needle aspiration in this setting is unclear. In this study, we sought to identify the clinical predictors of persistent N2 disease after induction therapy, which may help in selecting the patients most likely to benefit from surgical resection. METHODS: A retrospective review of a prospective database (1990 to 2014) was performed to identify patients who had surgical resection after induction therapy for clinical stage IIIA-N2 non-small cell lung cancer. Multivariable logistic regression analysis was performed to determine independent predictors of persistent N2 disease. RESULTS: 203 patients (56% female; median age 64 years) underwent potentially curative lung resection after induction therapy. Ninety-seven patients (48%) had pathologic nodal downstaging (pN0/N1), which was associated with significantly better overall survival compared with patients with persistent N2 disease (5 years, 56% versus 35%, p = 0.047). Univariate and multivariate analysis showed that upper or middle lobe location and less than 60% reduction of N2 SUVmax were independent predictors of persistent N2 disease. CONCLUSIONS: Patients with upper lobe tumors and less than 60% reduction in N2 SUVmax are more likely to have persistent N2 disease, which is often associated with poor survival rates. These clinical prognostic criteria may help surgeons in stratifying patients and properly selecting optimal surgical candidates.
[Mh] Termos MeSH primário: Antineoplásicos/uso terapêutico
Carcinoma Pulmonar de Células não Pequenas/secundário
Quimioterapia de Indução/métodos
Neoplasias Pulmonares/patologia
Linfonodos/diagnóstico por imagem
Estadiamento de Neoplasias
[Mh] Termos MeSH secundário: Idoso
Biópsia por Agulha Fina
Carcinoma Pulmonar de Células não Pequenas/diagnóstico
Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico
Feminino
Seguimentos
Seres Humanos
Neoplasias Pulmonares/tratamento farmacológico
Metástase Linfática
Masculino
Mediastinoscopia
Mediastino
Meia-Idade
Tomografia por Emissão de Pósitrons
Prognóstico
Estudos Retrospectivos
Fatores de Tempo
Tomografia Computadorizada por Raios X
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antineoplastic Agents)
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170828
[Lr] Data última revisão:
170828
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:160914
[St] Status:MEDLINE


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[PMID]:28043483
[Au] Autor:Spaggiari L; Casiraghi M; Guarize J; Brambilla D; Petrella F; Maisonneuve P; De Marinis F
[Ad] Endereço:Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy; School of Medicine, University of Milan, Milan, Italy.
[Ti] Título:Outcome of Patients With pN2 "Potentially Resectable" Nonsmall Cell Lung Cancer Who Underwent Surgery After Induction Chemotherapy.
[So] Source:Semin Thorac Cardiovasc Surg;28(2):593-602, 2016 Summer.
[Is] ISSN:1532-9488
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Patients with stage IIIA-ipsilateral mediastinal lymph node involvement (N2) non-small cell lung cancer (NSCLC) represent a heterogeneous group with different clinical presentation. The aim of this study was to analyze a series of patients with "potentially resectable" stage IIIA-pathologically proven N2 (pN2) NSCLC undergoing induction chemotherapy followed by surgery to evaluate their long-term outcomes and to identify prognostic factors. Out of 287 patients who underwent induction chemotherapy for NSCLC with ipsilateral mediastinal lymph node involvement pathologically proven, we retrospectively evaluated 141 (49%) patients with no clinical evidence of progression after induction chemotherapy and candidates for surgery. Most of them (73%) underwent at least 3 cycles of cisplatin-based chemotherapy. We used the Kaplan-Meier method to plot survival and the log-rank test to assess the survival difference between groups. Multivariable analysis was performed using Cox proportional hazards regression. A total of 15 (10.6%) patients underwent explorative thoracotomy; 126 patients underwent surgical anatomical resection after a median 27 days (range: 21-30) from the last cycle of chemotherapy. A total of 113 (89.7%) patients had a radical resection. A total of 22 (17.5%) patients had a complete pathologic lymph node downstaging (pN0), and 8 (6.3%) patients had a complete pathological response (pT0N0). The median overall survival was 24 months, with a 5-year overall survival of 30%. At multivariable analysis, downstaging and number of cycles of chemotherapy were independent prognostic factors (P = 0.006); downstaging benefit was mostly because of complete pathological response (hazards ratio = 0.23, 95% CI: 0.07-0.76). In conclusion, more than 3 cycles of chemotherapy and pathological downstaging could significantly improve 5-year survival in selected patients with "potentially resectable" pathologically proven N2 disease.
[Mh] Termos MeSH primário: Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico
Carcinoma Pulmonar de Células não Pequenas/terapia
Quimioterapia de Indução
Neoplasias Pulmonares/terapia
Terapia Neoadjuvante
Pneumonectomia
[Mh] Termos MeSH secundário: Idoso
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos
Carcinoma Pulmonar de Células não Pequenas/mortalidade
Carcinoma Pulmonar de Células não Pequenas/patologia
Quimioterapia Adjuvante
Cisplatino/administração & dosagem
Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico
Feminino
Seres Humanos
Quimioterapia de Indução/efeitos adversos
Quimioterapia de Indução/mortalidade
Estimativa de Kaplan-Meier
Neoplasias Pulmonares/mortalidade
Neoplasias Pulmonares/patologia
Masculino
Mediastinoscopia
Meia-Idade
Análise Multivariada
Terapia Neoadjuvante/efeitos adversos
Terapia Neoadjuvante/mortalidade
Estadiamento de Neoplasias
Pneumonectomia/efeitos adversos
Pneumonectomia/mortalidade
Valor Preditivo dos Testes
Modelos de Riscos Proporcionais
Estudos Retrospectivos
Fatores de Risco
Fatores de Tempo
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
Q20Q21Q62J (Cisplatin)
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170817
[Lr] Data última revisão:
170817
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170104
[St] Status:MEDLINE


  9 / 1510 MEDLINE  
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[PMID]:28018536
[Au] Autor:Grenda TR; Ballard TN; Obi AT; Pozehl W; Seagull FJ; Chen R; Cohn AM; Daskin MS; Reddy RM
[Ti] Título:Computer Modeling to Evaluate the Impact of Technology Changes on Resident Procedural Volume.
[So] Source:J Grad Med Educ;8(5):713-718, 2016 Dec.
[Is] ISSN:1949-8357
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND : As resident "index" procedures change in volume due to advances in technology or reliance on simulation, it may be difficult to ensure trainees meet case requirements. Training programs are in need of metrics to determine how many residents their institutional volume can support. OBJECTIVE : As a case study of how such metrics can be applied, we evaluated a case distribution simulation model to examine program-level mediastinoscopy and endobronchial ultrasound (EBUS) volumes needed to train thoracic surgery residents. METHODS : A computer model was created to simulate case distribution based on annual case volume, number of trainees, and rotation length. Single institutional case volume data (2011-2013) were applied, and 10 000 simulation years were run to predict the likelihood (95% confidence interval) of all residents (4 trainees) achieving board requirements for operative volume during a 2-year program. RESULTS : The mean annual mediastinoscopy volume was 43. In a simulation of pre-2012 board requirements (thoracic pathway, 25; cardiac pathway, 10), there was a 6% probability of all 4 residents meeting requirements. Under post-2012 requirements (thoracic, 15; cardiac, 10), however, the likelihood increased to 88%. When EBUS volume (mean 19 cases per year) was concurrently evaluated in the post-2012 era (thoracic, 10; cardiac, 0), the likelihood of all 4 residents meeting case requirements was only 23%. CONCLUSIONS : This model provides a metric to predict the probability of residents meeting case requirements in an era of changing volume by accounting for unpredictable and inequitable case distribution. It could be applied across operations, procedures, or disease diagnoses and may be particularly useful in developing resident curricula and schedules.
[Mh] Termos MeSH primário: Simulação por Computador
Internato e Residência/organização & administração
[Mh] Termos MeSH secundário: Broncoscopia/estatística & dados numéricos
Mediastinoscopia/estatística & dados numéricos
Cirurgia Torácica/educação
Ultrassonografia/estatística & dados numéricos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1703
[Cu] Atualização por classe:170302
[Lr] Data última revisão:
170302
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161227
[St] Status:MEDLINE
[do] DOI:10.4300/JGME-D-15-00503.1


  10 / 1510 MEDLINE  
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[PMID]:27846176
[Au] Autor:Nomura T; Matsutani T; Hagiwara N; Fujita I; Nakamura Y; Makino H; Miyashita M; Uchida E
[Ad] Endereço:*Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery †Department of Surgery, Tama-Nagayama Hospital ‡Department of Surgery, Chiba-Hokusou Hospital, Nippon Medical School, Tokyo, Japan.
[Ti] Título:Mediastinoscopy-assisted Transhiatal Esophagectomy for Esophageal Cancer: A Single-Institutional Cohort Study.
[So] Source:Surg Laparosc Endosc Percutan Tech;26(6):e153-e156, 2016 Dec.
[Is] ISSN:1534-4908
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:We compared the therapeutic outcomes of mediastinoscopy-assisted transhiatal esophagectomy (MATHE) with transthoracic esophagectomy (TTE), and with video-assisted thoracoscopic esophagectomy (VATS-E) for the treatment of esophageal cancer. Twenty patients underwent MATHE in our institute from 2001 to 2005 were enrolled. We evaluated the therapeutic outcomes, including perioperative complications and long-term prognosis after surgery, and compared these with 15 patients who underwent TTE during the same time period and 15 who underwent VATS-E at a later date. MATHE was performed safely and the long-term prognosis were satisfactory compared with TTE. However, the number of dissected mediastinal lymph nodes, total blood loss, and sophistication of the procedure were inferior to VATS-E. MATHE represents a less invasive surgical procedure. However, in light of the risk of leaving lymph node metastasis around the tracheal bifurcation in patients with tumor invasion beyond the muscularis mucosa, MATHE should only be adopted in a minority of patients.
[Mh] Termos MeSH primário: Neoplasias Esofágicas/cirurgia
Esofagectomia/métodos
Mediastinoscopia/métodos
Cirurgia Torácica Vídeoassistida/métodos
[Mh] Termos MeSH secundário: Idoso
Endossonografia
Neoplasias Esofágicas/diagnóstico
Feminino
Seguimentos
Gastroscopia
Seres Humanos
Masculino
Meia-Idade
Estadiamento de Neoplasias
Estudos Retrospectivos
Fatores de Tempo
Tomografia Computadorizada por Raios X
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170418
[Lr] Data última revisão:
170418
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161116
[St] Status:MEDLINE



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