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Caso R, Watson TJ, Tefera E, Cerfolio R, Abbas AE, Lazar JF, Margolis M, Hwalek AE, Khaitan PG. Comparing Robotic, Thoracoscopic, and Open Segmentectomy: A National Cancer Database Analysis. J Surg Res 2024; 296:674-680. [PMID: 38359682 DOI: 10.1016/j.jss.2024.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 01/08/2024] [Accepted: 01/17/2024] [Indexed: 02/17/2024]
Abstract
INTRODUCTION Minimally invasive approaches to lung resection have become widely acceptable and more recently, segmentectomy has demonstrated equivalent oncologic outcomes when compared to lobectomy for early-stage non-small cell lung cancer (NSCLC). However, studies comparing outcomes following segmentectomy by different surgical approaches are lacking. Our objective was to investigate the outcomes of patients undergoing robotic, video-assisted thoracoscopic surgery (VATS), or open segmentectomy for NSCLC using the National Cancer Database. METHODS NSCLC patients with clinical stage I who underwent segmentectomy from 2010 to 2016 were identified. After propensity-score matching (1:4:1), multivariate logistic regression analyses were performed to determine predictors of 30-d readmissions, 90-d mortality, and overall survival. RESULTS 22,792 patients met study inclusion. After matching, approaches included robotic (n = 2493; 17%), VATS (n = 9972; 66%), and open (n = 2493; 17%). An open approach was associated with higher 30-d readmissions (7% open versus 5.5% VATS versus 5.6% robot, P = 0.033) and 90-d mortality (4.4% open versus 2.2% VATS versus 2.5% robot, P < 0.001). A robotic approach was associated with improved 5-y survival (50% open versus 58% VATS versus 63% robot, P < 0.001). CONCLUSIONS For patients with clinical stage I NSCLC undergoing segmentectomy, compared to the open approach, a VATS approach was associated with lower 30-d readmission and 90-d mortality. A robotic approach was associated with improved 5-y survival compared to open and VATS approaches when matched. Additional studies are necessary to determine if unrecognized covariates contribute to these differences.
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Affiliation(s)
- Raul Caso
- Department of Surgery, Georgetown University School of Medicine, Medstar Washington Hospital Center, Washington, District of Columbia
| | - Thomas J Watson
- Division of Thoracic Surgery, Department of Surgery, Beaumont Health, Detroit, Michigan
| | - Eshetu Tefera
- Department of Biostatistics and Biomedical Informatics, Medstar Health Research Institute, Washington, District of Columbia
| | - Robert Cerfolio
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York
| | - Abbas E Abbas
- Division of Thoracic Surgery, Department of Surgery, Brown University, Providence, Rhode Island
| | - John F Lazar
- Department of Surgery, Georgetown University School of Medicine, Medstar Washington Hospital Center, Washington, District of Columbia; Division of Thoracic Surgery, Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia
| | - Marc Margolis
- Department of Surgery, Georgetown University School of Medicine, Medstar Washington Hospital Center, Washington, District of Columbia; Division of Thoracic Surgery, Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia
| | - Ann E Hwalek
- Department of Surgery, Georgetown University School of Medicine, Medstar Washington Hospital Center, Washington, District of Columbia; Division of Thoracic Surgery, Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia
| | - Puja Gaur Khaitan
- Department of Surgery, Georgetown University School of Medicine, Medstar Washington Hospital Center, Washington, District of Columbia; Division of Thoracic Surgery, Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia; Division of Thoracic Surgery, Department of Surgery, Sheikh Shakhbout Medical City, Khalifa University, Abu Dhabi, UAE.
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Sutton W, O'Neill J, Strother E, Grossman DA, Hwalek AE, Margolis M. Video-assisted thoracic surgery and robotic-assisted first-rib excision and thoracic outlet syndrome decompression. Semin Vasc Surg 2024; 37:82-89. [PMID: 38704188 DOI: 10.1053/j.semvascsurg.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 02/11/2024] [Accepted: 02/12/2024] [Indexed: 05/06/2024]
Abstract
Multiple surgical approaches have been used in the management of thoracic outlet syndrome. These approaches have traditionally been "open" approaches and have been associated with the inherent morbidities of an open approach, including a risk of injury to the neurovascular structures due to traction and trauma while resecting the first rib. In addition, there has been concern that recurrence of symptoms may be related to incomplete resection of the rib with conventional open techniques. With the advent of minimally invasive thoracic surgery, surgeons began to explore first-rib resection via a thoracoscopic approach. Unfortunately, the existing video-assisted thoracic surgery technology and equipment was not well suited to working in the apex of the chest. With the introduction and subsequent progress in robotic surgery and instrumentation, this dissection can be performed with all the advantages of robotics, but also with minimal traction and trauma to the neurovascular structures, and incorporates almost complete resection of the rib with minimal residual stump. Robotics has developed as a reliable, safe, and less invasive approach to first-rib resection, yielding excellent results while limiting the morbidity of the procedure.
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Affiliation(s)
- Whitney Sutton
- Department of Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Road, Washington, DC, 20007.
| | - John O'Neill
- Department of Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Road, Washington, DC, 20007
| | - Eric Strother
- Department of Cardiothoracic Surgery, MedStar Georgetown University Hospital, Washington, DC
| | - Danielle A Grossman
- Department of Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Road, Washington, DC, 20007
| | - Ann E Hwalek
- Department of Cardiothoracic Surgery, MedStar Georgetown University Hospital, Washington, DC
| | - Marc Margolis
- Department of Cardiothoracic Surgery, MedStar Georgetown University Hospital, Washington, DC
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Carrasquilla M, Paudel N, Collins BT, Anderson E, Krochmal R, Margolis M, Balawi A, DeBlois D, Giaccone G, Kim C, Liu S, Lischalk JW. High-Risk Non-Small Cell Lung Cancer Treated With Active Scanning Proton Beam Radiation Therapy and Immunotherapy. Adv Radiat Oncol 2022; 8:101125. [PMID: 36578277 PMCID: PMC9791120 DOI: 10.1016/j.adro.2022.101125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 10/31/2022] [Indexed: 11/27/2022] Open
Abstract
Purpose Non-small cell lung cancer (NSCLC) is a deadly malignancy that is frequently diagnosed in patients with significant medical comorbidities. When delivering local and regional therapy, an exceedingly narrow therapeutic window is encountered, which often precludes patients from receiving aggressive curative therapy. Radiation therapy advances including particle therapy have been employed in an effort to expand this therapeutic window. Here we report outcomes with the use of proton therapy with curative intent and immunotherapy to treat patients diagnosed with high-risk NSCLC. Methods and Materials Patients were determined to be high risk if they had severe underlying cardiopulmonary dysfunction, history of prior thoracic radiation therapy, and/or large volume or unfavorable location of disease (eg, bilateral hilar involvement, supraclavicular involvement). As such, patients were determined to be ineligible for conventional x-ray-based radiation therapy and were treated with pencil beam scanning proton beam therapy (PBS-PBT). Patients who demonstrated excess respiratory motion (ie, greater than 1 cm in any dimension noted on the 4-dimensional computed tomography simulation scan) were deemed to be ineligible for PBT. Toxicity was reported using the Common Terminology Criteria for Adverse Events (CTCAE), version 5.0. Overall survival and progression-free survival were calculated using the Kaplan-Meier method. Results A total of 29 patients with high-risk NSCLC diagnoses were treated with PBS-PBT. The majority (55%) of patients were defined as high risk due to severe cardiopulmonary dysfunction. Most commonly, patients were treated definitively to a total dose of 6000 cGy (relative biological effectiveness) in 30 fractions with concurrent chemotherapy. Overall, there were a total of 6 acute grade 3 toxicities observed in our cohort. Acute high-grade toxicities included esophagitis (n = 4, 14%), dyspnea (n = 1, 3.5%), and cough (n = 1, 3.5%). No patients developed grade 4 or higher toxicity. The majority of patients went on to receive immunotherapy, and high-grade pneumonitis was rare. Two-year progression-free and overall survival was estimated to be 51% and 67%, respectively. COVID-19 was confirmed or suspected to be responsible for 2 patient deaths during the follow-up period. Conclusions Radical PBS-PBT treatment delivered in a cohort of patients with high-risk lung cancer with immunotherapy is feasible with careful multidisciplinary evaluation and rigorous follow-up.
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Affiliation(s)
- Michael Carrasquilla
- Department of Radiation Medicine, MedStar Georgetown University Hospital, Washington, DC
| | - Nitika Paudel
- Department of Radiation Medicine, MedStar Georgetown University Hospital, Washington, DC
| | - Brian T. Collins
- Department of Radiation Medicine, MedStar Georgetown University Hospital, Washington, DC
| | - Eric Anderson
- Division of Pulmonary and Critical Care Medicine, MedStar Georgetown University Hospital, Washington, DC
| | - Rebecca Krochmal
- Division of Pulmonary and Critical Care Medicine, MedStar Georgetown University Hospital, Washington, DC
| | - Marc Margolis
- Division of Thoracic Surgery, MedStar Georgetown University Hospital, Washington, DC
| | - Ahssan Balawi
- Department of Radiation Medicine, MedStar Georgetown University Hospital, Washington, DC
| | - David DeBlois
- Department of Radiation Medicine, MedStar Georgetown University Hospital, Washington, DC
| | - Giuseppe Giaccone
- Department of Hematology and Oncology, Weill Cornell Medical Center, New York, New York
| | - Chul Kim
- Lombardi Cancer Center, MedStar Georgetown University Hospital, Washington, DC
| | - Stephen Liu
- Lombardi Cancer Center, MedStar Georgetown University Hospital, Washington, DC
| | - Jonathan W. Lischalk
- Department of Radiation Oncology, Perlmutter Cancer Center at New York University Langone Hospital – Long Island, New York, New York,Corresponding author: Jonathan W. Lischalk, MD
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Anderson E, Margolis M, Krochmal R, Hwalek A, DeBrito P, Sidawy M, Liu S, Kim C, Reuss J, Paudel N, Strother E, Hamm M. EP02.03-008 Combined Robotic Assisted Thoracic Surgery (CRATS). J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Mortazavi A, Mualem W, Dowlati E, Alexander H, Rotter J, Withington C, Margolis M, Voyadzis JM. Anterior lumbar interbody fusion: single institutional review of complications and associated variables. Spine J 2022; 22:454-462. [PMID: 34600108 DOI: 10.1016/j.spinee.2021.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 09/10/2021] [Accepted: 09/21/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT As more patients undergo anterior lumbar interbody fusion (ALIF) procedures and more devices are created for that purpose, it is important to understand the complications that can arise and the variables that mitigate risk for major and minor complications. PURPOSE To assess complication rates after ALIF with or without posterior instrumentation and variables associated with increased likelihood of postoperative complications. We aim to provide this data as benchmarking to improve patient safety and surgical care. STUDY DESIGN A single-center retrospective cohort study. PATIENT SAMPLE All adult patients who underwent ALIF between 2017 and 2019 was performed OUTCOME MEASURES: Post-operative major and minor complications were evaluated. METHODS Complications were recorded and presented as percentages. Patient demographics, perioperative, and postoperative data were also collected and analyzed between patients who had no complications and those that had any complication. Subgroup analysis of surgical complications were performed by nonparametric Chi-square tests. Continuous variables were compared using Mann-Whitney U tests. RESULTS Ninty-five of three hundred sixty-two (26.2%) of patients experienced a minor or major complication. Among the most common complications found were surgical site infections (5.8%), neurological complications (4.1%), vascular complications (3.6%), and urinary tract infections (3.3%). Patients undergoing ALIF alone with post-operative complications had higher mean age, higher BMI, higher ASA status, and experienced higher estimated blood loss. Patients undergoing ALIF and posterior instrumentation with post-operative complications were more likely to have diabetes and had a higher ASA status. Patients with any complications from both groups had longer length of stay, discharge to a non-home setting and were more likely to be readmitted or return to the operating room. CONCLUSION Our study reveals variables associated with complications at our institution, including age of the patient, BMI, and ASA status leading to higher complications and greater LOS, higher readmission rates, and disposition to skilled facilities.
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Affiliation(s)
- Armin Mortazavi
- Georgetown University School of Medicine, 3900 Reservoir Rd, Washington, DC, USA
| | - William Mualem
- Georgetown University School of Medicine, 3900 Reservoir Rd, Washington, DC, USA
| | - Ehsan Dowlati
- Department of Neurosurgery, 3800 Reservoir Rd, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Hepzibha Alexander
- Division of Neurosurgery, 16001 W Nine Mile Rd, Ascension Providence Hospital, College of Human Medicine, Michigan State University, Southfield, MI, USA
| | - Juliana Rotter
- Department of Neurological Surgery, 200 1st St NW, Mayo Clinic, Rochester, MN, USA
| | - Charles Withington
- Georgetown University School of Medicine, 3900 Reservoir Rd, Washington, DC, USA
| | - Marc Margolis
- Division of Thoracic Surgery, 3800 Reservoir Rd, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Jean-Marc Voyadzis
- Department of Neurosurgery, 3800 Reservoir Rd, MedStar Georgetown University Hospital, Washington, DC, USA.
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Aghdam N, Lischalk JW, Marin MP, Hall C, O'Connor T, Campbell L, Suy S, Collins SP, Margolis M, Krochmal R, Anderson E, Collins BT. Lobar Gross Endobronchial Disease Predicts for Overall Survival and Grade 5 Pulmonary Toxicity in Medically Inoperable Early Stage Non-Small Cell Lung Cancer Patients Treated With Stereotactic Body Radiation Therapy. Front Oncol 2021; 11:728519. [PMID: 34912703 PMCID: PMC8667471 DOI: 10.3389/fonc.2021.728519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/18/2021] [Indexed: 12/31/2022] Open
Abstract
Purpose Stereotactic body radiation therapy (SBRT) is considered standard of care for medically inoperable early stage non-small cell lung cancer (ES-NSCLC). Central tumor location is a known risk factor for severe SBRT related toxicity. Bronchoscopy allows for visualization of the central airways prior to treatment. Five fraction SBRT approaches have been advocated to mitigate treatment induced toxicity. In this report, we examine the mature clinical outcomes of a diverse cohort of ES-NSCLC patients with both peripheral and central tumors treated with a conservative 5 fraction SBRT approach and evaluate the role of lobar gross endobronchial disease (LGED) in predicting overall survival and treatment-related death. Methods Medically inoperable biopsy-proven, lymph node-negative ES-NSCLC patients were treated with SBRT. Bronchoscopy was completed prior to treatment in all centrally located cases. The Kaplan-Meier method was used to estimate overall survival (OS), local control (LC), regional control (RC), distant metastasis free survival (DMFS) and disease-free survival (DFS). Overall survival was stratified based on clinical stage, histology, tumor location and LGED. Toxicities were scored according to the National Cancer Institute Common Terminology Criteria for Adverse Events, Version 5.0. Results From December 2010 to December 2015, 50 consecutive patients were treated uniformly with a 50 Gy in 5 fraction SBRT approach (tumor BED10 ≥ 100 Gy) and followed for a minimum of 5 years or until death. At a median follow up of 42 months for all patients, 3-year OS was 50%. Three-year OS did not statistically differ between stage I and stage II disease (51% vs. 47%; p=0.86), adenocarcinoma and squamous cell carcinoma (50% vs. 45%; p=0.68), or peripheral and central tumors (56% vs. 45%; p=0.46). Five central tumors were found to have LGED, and 3-year OS for this cohort was quite poor at 20%. Cox regression analysis identified LGED as a predictor of OS while controlling for age, stage and location (OR:4.536, p-value=0.038). Despite the relatively low dose delivered, treatment likely contributed to the death of 4 patients with central tumors. Lobar gross endobronchial disease was an independent predictor for grade 5 pulmonary toxicity (n=4, p=0.007). Specifically, 3 of the 5 patients with LGED developed fatal radiation-induced bronchial stricture. Three-year LC, RC, DMFS and DFS results for the group were similar to contemporary studies at 90%, 90%, 82% and 65%. Conclusions Central location of ES-NSCLC is a well-established predictor for severe SBRT-related toxicity. Here we identify LGED as a significant predictor of poor overall survival and grade 5 pulmonary toxicity. The relatively high rates of severe treatment-related toxicity seen in patients with central ES-NSCLC may be due in part to LGED. Underlying LGED may cause irreparable damage to the lobar airway, unmitigated by SBRT treatment thus increasing the risk of severe treatment-related toxicity. These findings should be verified in larger data sets. Future prospective central ES-NSCLC clinical trials should require staging bronchoscopy to identify LGED and further assess its clinical significance.
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Affiliation(s)
- Nima Aghdam
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Jonathan W Lischalk
- Department of Radiation Oncology, Perlmutter Cancer Center New York University at Langone Hospital - Long Island, New York, NY, United States
| | - Monica Pernia Marin
- Geriatrics and Palliative Medicine Division, George Washington University Hospital, Washington, DC, United States
| | - Clare Hall
- College of Arts and Sciences, Cornell University, Ithaca, NY, United States
| | - Timothy O'Connor
- Georgetown University School of Medicine, Washington, DC, United States
| | - Lloyd Campbell
- Department of Radiation Medicine, MedStar Georgetown University Hospital, Washington, DC, United States
| | - Simeng Suy
- Department of Radiation Medicine, MedStar Georgetown University Hospital, Washington, DC, United States
| | - Sean P Collins
- Department of Radiation Medicine, MedStar Georgetown University Hospital, Washington, DC, United States
| | - Marc Margolis
- Division of Thoracic Surgery, MedStar Georgetown University Hospital, Washington, DC, United States
| | - Rebecca Krochmal
- Division of Pulmonary and Critical Care Medicine, MedStar Georgetown University Hospital, Washington, DC, United States
| | - Eric Anderson
- Division of Pulmonary and Critical Care Medicine, MedStar Georgetown University Hospital, Washington, DC, United States
| | - Brian T Collins
- Department of Radiation Medicine, MedStar Georgetown University Hospital, Washington, DC, United States
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Oza K, Peesay T, Greenspun B, Carroll JE, Shafa S, Zeck JC, Haddad NG, Margolis M, Khaitan PG. Long-term outcomes of endoscopic mucosal resection for early-stage esophageal adenocarcinoma. Surg Endosc 2021; 36:5136-5143. [PMID: 34845554 DOI: 10.1007/s00464-021-08884-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 11/16/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND With growing application of endoscopic therapy for early-stage esophageal cancer, we sought to review our experience of endoscopic mucosal resections (EMRs). The aim of our study was to understand the natural course of these patients, especially with positive margins. METHODS A prospectively maintained database of all patients undergoing endoscopic therapies at Georgetown University Hospital for esophageal cancer was used for the analysis between 2010 and 2020. RESULTS Of 80 patients in the EMR database, 35 were performed as index cases for esophageal adenocarcinoma. Majority (74.3%) had a pre-treatment ultrasound confirming absence of regional adenopathy. There were no post-EMR bleeding or perforation events requiring re-intervention. Complete R0 resection was achieved in 22/35 (62.9%) after initial EMR. Thirteen patients had positive margins. Of these 13 patients, only 7 patients underwent repeat endoscopic resection, 2 underwent subsequent esophagectomy, 2 received definitive radiation given poor surgical candidacy, and 2 were lost to follow-up. Overall and 5-year survival of all patients undergoing EMR was 67.9 months and 85%, respectively. Subset analysis of the 13 patients with R1 resection demonstrated an overall survival of 49.2 months and 60% 5-year survival vs overall survival of 78.9 months and 93% 5-year survival for R0 resection. At a median follow-up of 60.5 months, cancer recurrence occurred in 3 patients. All of them were successfully managed with repeat EMR. CONCLUSIONS Endoscopic resections represent a safe and effective treatment for early-stage esophageal cancer. Patients with high-risk features should be counseled to undergo an esophagectomy if they are operable candidates.
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Affiliation(s)
- Kesha Oza
- Department of General Surgery, Georgetown University School of Medicine, Medstar Washington Hospital Center, Washington, DC, USA
| | - Tejasvi Peesay
- Department of General Surgery, Georgetown University School of Medicine, Medstar Washington Hospital Center, Washington, DC, USA
| | - Benjamin Greenspun
- Department of General Surgery, Georgetown University School of Medicine, Medstar Washington Hospital Center, Washington, DC, USA
| | - John E Carroll
- Department of Gastroenterology, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Shervin Shafa
- Department of Gastroenterology, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Jay C Zeck
- Department of Pathology, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Nadim G Haddad
- Department of Gastroenterology, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Marc Margolis
- Department of General Surgery, Division of Thoracic Surgery, Georgetown University School of Medicine, Medstar Washington Hospital Center, 110 Irving Street, NW (G253), Washington, DC, 20010, USA
| | - Puja Gaur Khaitan
- Department of General Surgery, Division of Thoracic Surgery, Georgetown University School of Medicine, Medstar Washington Hospital Center, 110 Irving Street, NW (G253), Washington, DC, 20010, USA.
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Cain CJ, Margolis M, Lazar JF, Henderson H, Hamm M, Malouf S, Khaitan PG. Short and long-term outcomes of surgical intervention for empyema in the post-fibrinolytic era. J Cardiothorac Surg 2021; 16:187. [PMID: 34215289 PMCID: PMC8254344 DOI: 10.1186/s13019-021-01566-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 06/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Open window thoracostomy (OWT) is indicated for patients with bronchopleural fistula (BPF) or trapped lung in the setting of empyema refractory to non-surgical interventions. We investigated the role of OWT in the era of minimally invasive surgeries, endobronchial valves and fibrinolytic therapy. METHODS A retrospective chart review of all patients who underwent OWT at a single institution from 2010 to 2020 was performed. Indications for the procedure as well as operative details and morbidity and mortality were evaluated to determine patient outcomes for OWT. RESULTS Eighteen patients were identified for the study. The most common indication for OWT was post-resectional BPF (n = 9). Prior to OWT, n = 11 patients failed other surgical or minimally invasive interventions. Patient comorbidities were quantified with the Charlson Comorbidity index (n = 11 score ≥ 5, 10-year survival ≤21%). Three (16.7%) patients died < 30 days post-operatively and 12 (66%) patients were deceased by the study's end (overall survival 24.0 ± 32.2 months). Mean number of ribs resected were 2.5 ± 1.2 (range 1-6) with one patient having 6 ribs removed. Patients were managed with negative pressure wound therapy (n = 9) or Kerlix packing (n = 9). Eleven patients (61.6%) underwent delayed closure (mean time from index surgery to closure 4.8 ± 6.7 months). CONCLUSIONS Our study illustrates the significant comorbidities of patients undergoing OWT, the poor outcomes therein, and pitfalls associated with this procedure. We show that negative pressure wound therapy can be utilized as potential way to obliterate the pleural space and manage an open chest in the absence of an airleak; however, OWT procedures continue to be extremely morbid.
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Affiliation(s)
- Caitlin J Cain
- Department of General Surgery, Georgetown University School of Medicine, Medstar Washington Hospital Center, 110 Irving Street, NW (G253), Washington DC, 20010, USA
| | - Marc Margolis
- Department of General Surgery, Georgetown University School of Medicine, Medstar Washington Hospital Center, 110 Irving Street, NW (G253), Washington DC, 20010, USA.,Division of Thoracic Surgery, Georgetown University School of Medicine, Medstar Washington Hospital Center, 110 Irving Street, NW (G253), Washington DC, 20010, USA
| | - John F Lazar
- Department of General Surgery, Georgetown University School of Medicine, Medstar Washington Hospital Center, 110 Irving Street, NW (G253), Washington DC, 20010, USA.,Division of Thoracic Surgery, Georgetown University School of Medicine, Medstar Washington Hospital Center, 110 Irving Street, NW (G253), Washington DC, 20010, USA
| | - Hayley Henderson
- Division of Thoracic Surgery, Georgetown University School of Medicine, Medstar Washington Hospital Center, 110 Irving Street, NW (G253), Washington DC, 20010, USA
| | - Margaret Hamm
- Division of Thoracic Surgery, Georgetown University School of Medicine, Medstar Washington Hospital Center, 110 Irving Street, NW (G253), Washington DC, 20010, USA
| | - Stefanie Malouf
- Division of Thoracic Surgery, Georgetown University School of Medicine, Medstar Washington Hospital Center, 110 Irving Street, NW (G253), Washington DC, 20010, USA
| | - Puja Gaur Khaitan
- Department of General Surgery, Georgetown University School of Medicine, Medstar Washington Hospital Center, 110 Irving Street, NW (G253), Washington DC, 20010, USA. .,Division of Thoracic Surgery, Georgetown University School of Medicine, Medstar Washington Hospital Center, 110 Irving Street, NW (G253), Washington DC, 20010, USA.
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McGunigal M, Margolis M, Forsthoefel M, Singh T, Amarell K, Deblois D, Campbell L, Kim C, Liu S, Bergquist PJ, Debrito P, Collins BT, Giaccone G, Lischalk JW. Thymic malignancies treated with active scanning proton beam radiation and Monte Carlo planning: early clinical experience. Acta Oncol 2021; 60:649-652. [PMID: 33629926 DOI: 10.1080/0284186x.2021.1887516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Mary McGunigal
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - Marc Margolis
- Division of Thoracic and Esophageal Surgery, Department of Surgery, Georgetown University Hospital, Washington, DC, USA
| | - Matthew Forsthoefel
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - Tanvee Singh
- Georgetown University School of Medicine, Washington, DC, USA
| | | | - David Deblois
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - Lloyd Campbell
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - Chul Kim
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC, USA
| | - Stephen Liu
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC, USA
| | - Peter J. Bergquist
- Department of Radiology, Georgetown University Hospital, Washington, DC, USA
| | - Pedro Debrito
- Department of Pathology, Georgetown University Hospital, Washington, DC, USA
| | - Brian T. Collins
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA
| | - Giuseppe Giaccone
- Department of Oncology, Weill Cornell Medical Center, New York, NY, USA
| | - Jonathan W. Lischalk
- Department of Radiation Oncology, Perlmutter Cancer Center at New York University Winthrop Hospital, New York, NY, USA
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Kong WY, Bustamante G, Margolis M, McRee AL, Pallotto IK, Gilkey MB. Recommending Inequality? Patterns of US Healthcare Providers' HPV Vaccine Recommendations. Cancer Epidemiol Biomarkers Prev 2021. [DOI: 10.1158/1055-9965.epi-21-0218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Purpose: Infrequent provider recommendations continue to be a key barrier to human papillomavirus (HPV) vaccination, including among adolescents at higher risk for future HPV cancers. To inform future provider- training programs, our study sought to synthesize the findings of existing studies of disparities in provider recommendation of HPV vaccination among adolescents. Methods: We conducted a systematic review of studies that quantitatively assessed the prevalence of provider recommendation of HPV vaccination among US parents of adolescents aged 9–17. We excluded studies that were not empirical, not peer-reviewed, or collected data before 2012. Following PRISMA guidelines, two independent coders extracted and screened 3,158 unique titles and abstracts from multiple databases. Next, two independent coders reviewed the full text of eligible studies, systematically collecting data using a standardized abstraction form. We resolved coding disagreements via discussion with the whole team. Results: Fifty-four of 252 reviewed studies met eligibility criteria, including 33 studies of parents and 21 studies of providers. Parental report of receiving a provider recommendation for HPV vaccination ranged from 22% to 78%. These studies most often assessed disparities by adolescents' sex, with almost all finding that provider recommendations were less common for boys vs. girls. Most studies of provider reports confirmed disparate recommendations by sex. Fewer studies stratified recommendation disparities by income or race/ethnicity; these studies found that recommendations were less common among lower-income households, but reported mixed findings by race/ethnicity. Geographic assessments found variation across states and urbanicity, with recommendations being lower including in some Southern states and in rural areas. Conclusion: Findings suggest differences in provider recommendation by sex, household income, geography, and possibly race/ethnicity, in spite of national guidelines for routine HPV vaccination. National efforts to improve provider communication about HPV vaccination should focus on improving recommendation consistency, especially for populations such as lower-income and rural adolescents who are at higher risk for future HPV cancers.
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Carrasquilla M, Krochmal R, Anderson E, Bergquist P, Margolis M, Forsthoefel M, Collins B, Kim C, Liu S, Lischalk J. P05.13 Central vs Peripheral Thoracic Malignancies Treated with SBRT: Early Outcomes of a Prospective Quality of Life Study. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Famiglietti A, Lazar JF, Henderson H, Hamm M, Malouf S, Margolis M, Watson TJ, Khaitan PG. Management of anastomotic leaks after esophagectomy and gastric pull-up. J Thorac Dis 2020; 12:1022-1030. [PMID: 32274171 PMCID: PMC7139088 DOI: 10.21037/jtd.2020.01.15] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Anastomotic leak is one of the most feared complications of esophagectomy, leading to prolonged hospital stay, increased postoperative mortality, and additional cost both to the patient and the hospital. Historically, anastomotic leaks have been treated with several techniques including conservative measures, percutaneous or operative drainage, primary surgical repair with buttressing, T-tube drainage, or excision of the esophageal replacement conduit with end esophagostomy. With advances in treatment modalities, including endoscopic stenting, clips and suturing, endoluminal vacuum-assisted closure (EVAC), such leaks increasingly are being managed without operative re-intervention and with salvage of the esophageal replacement conduit. For the purposes of this review, we identified studies analyzing the management of postoperative leak after esophagectomy. We then compared the efficacy of the various newer modalities for closure of anastomotic leaks and gastric conduit defects. We found both esophageal stent and EVAC sponges are effective treatments for closure of anastomotic leak. The chosen treatment modality for salvage of the esophageal replacement conduit is entirely dependent on the patient’s clinical status and the surgeon’s preference and experience. Emerging endoscopic and endoluminal therapies have increased the armamentarium of tools the esophageal surgeon has to facilitate successful resolution of anastomotic leaks following esophagectomy with reconstruction. While some literature suggests that EVACs have a slightly superior result in conduit success, we question this endorsement as EVACs mostly are utilized for contained leaks, many of which may have healed with conservative measures. This poses a challenge as there is clearly a bias given patient selection.
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Affiliation(s)
- Amber Famiglietti
- Department of Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC, USA
| | - John F. Lazar
- Department of Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC, USA
- Division of Thoracic and Esophageal Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC, USA
| | - Hayley Henderson
- Department of Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC, USA
- Division of Thoracic and Esophageal Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC, USA
| | - Margaret Hamm
- Department of Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC, USA
- Division of Thoracic and Esophageal Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC, USA
| | - Stefanie Malouf
- Department of Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC, USA
- Division of Thoracic and Esophageal Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC, USA
| | - Marc Margolis
- Department of Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC, USA
- Division of Thoracic and Esophageal Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC, USA
| | - Thomas J. Watson
- Department of Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC, USA
- Division of Thoracic and Esophageal Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC, USA
| | - Puja Gaur Khaitan
- Department of Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC, USA
- Division of Thoracic and Esophageal Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC, USA
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Hynes CF, Kwon DH, Vadlamudi C, Lofthus A, Iwamoto A, Chahine JJ, Desale S, Margolis M, Kallakury BV, Watson TJ, Haddad NG, Marshall MB. Programmed Death Ligand 1: A Step Toward Immunoscore for Esophageal Cancer. Ann Thorac Surg 2018; 106:1002-1007. [PMID: 29859152 DOI: 10.1016/j.athoracsur.2018.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 04/24/2018] [Accepted: 05/01/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND This study sought to evaluate the effect of tumor-infiltrating lymphocyte (TIL) density and programmed death ligand 1 (PD-L1) expression on the prognosis of esophageal cancer. METHODS Banked tissue specimens from 53 patients who underwent esophagectomies for malignancy at a single institution over a 6-year period were stained for cluster of differentiation 3 (CD3), CD8, and PD-L1. Tumors were characterized as staining high or low density for CD3 and CD8, as well as positive or negative for PD-L1. TIL density and PD-L1 expression were analyzed in the context of survival, recurrence, and perioperative characteristics. RESULTS Median follow-up was 823 days, with 92.5% survival and 26.8% recurrence rates. All tumors were adenocarcinomas. Neoadjuvant chemotherapy was given in 56.6% of cases, and neoadjuvant radiotherapy was given in 37.7%. High CD3 density was found in 83%, whereas high CD8 density was found in 56.6%. A total of 18.9% of the tumors stained positive for PD-L1. Survival was significantly shorter in Kaplan-Meier analysis for patients with primary tumors staining positive for PD-L1 (log rank: p = 0.05). Multivariable analysis controlling for neoadjuvant therapy, TIL markers, PD-L1, age, and sex found no significant difference in recurrence or survival. CONCLUSIONS Positive staining for PD-L1 may be a prognostic marker for decreased survival in esophageal adenocarcinoma. Additional TIL cell types should be investigated for creation of an esophageal cancer Immunoscore. PD-L1 has potential as a therapeutic target.
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Affiliation(s)
- Conor F Hynes
- Division of Thoracic and Esophageal Surgery, Department of Surgery, MedStar Georgetown University Hospital, Washington, DC.
| | - Dong H Kwon
- Department of Pathology, MedStar Georgetown University Hospital, Washington, DC
| | - Chaitanya Vadlamudi
- Division of Thoracic and Esophageal Surgery, Department of Surgery, MedStar Georgetown University Hospital, Washington, DC
| | - Alexander Lofthus
- Division of Thoracic and Esophageal Surgery, Department of Surgery, MedStar Georgetown University Hospital, Washington, DC
| | - Aya Iwamoto
- Division of Thoracic and Esophageal Surgery, Department of Surgery, MedStar Georgetown University Hospital, Washington, DC
| | - Joeffrey J Chahine
- Department of Pathology, MedStar Georgetown University Hospital, Washington, DC
| | - Sameer Desale
- Department of Biostatistics and Bioinformatics, MedStar Health Research Institute, Washington, DC
| | - Marc Margolis
- Division of Thoracic and Esophageal Surgery, Department of Surgery, MedStar Georgetown University Hospital, Washington, DC
| | - Bhaskar V Kallakury
- Department of Pathology, MedStar Georgetown University Hospital, Washington, DC
| | - Thomas J Watson
- Division of Thoracic and Esophageal Surgery, Department of Surgery, MedStar Georgetown University Hospital, Washington, DC
| | - Nadim G Haddad
- Division of Gastroenterology, Department of Medicine, MedStar Georgetown University Hospital, Washington, DC
| | - M Blair Marshall
- Division of Thoracic and Esophageal Surgery, Department of Surgery, MedStar Georgetown University Hospital, Washington, DC
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Parascandola SA, Ibañez J, Keir G, Anderson J, Plankey M, Flynn D, Cody C, De Marchi L, Margolis M, Blair Marshall M. Liposomal bupivacaine versus bupivacaine/epinephrine after video-assisted thoracoscopic wedge resection†. Interact Cardiovasc Thorac Surg 2017; 24:925-930. [DOI: 10.1093/icvts/ivx044] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 01/03/2017] [Indexed: 11/12/2022] Open
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15
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Schuenemeyer J, Hong Y, Plankey M, Allen M, Margolis M, Johnson L, De Marchi L, Blair Marshall M. Foreign body entrapment during thoracic surgery—time for closed loop communication†. Eur J Cardiothorac Surg 2017; 51:852-855. [DOI: 10.1093/ejcts/ezw427] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 11/30/2016] [Indexed: 11/14/2022] Open
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Abstract
In this paper two questions are asked: To what extent do the Canadian and US publics differ in their beliefs about firearms-control legislation, and to what extent do these differences help to account for the stricter firearms legislation found in Canada? Surveys indicate that Canadians and Americans have remarkably similar attitudes towards firearms and gun control. Linear regression is used to analyze the factors that underlie the popular support for (or opposition to) stricter gun-control legislation. It is found that, with respect to support for gun control, cultural differences between Canadians and Americans are overshadowed by socioeconomic variables, such as gender and gun ownership.The similarities in public attitudes between Canadians and Americans suggest that the explanation for stricter firearms legislation in Canada lies more with the differences in political elites and institutions than with differences in public opinion. The differences in public attitudes in the two countries are insufficient to explain the stark contrast in firearms legislation.
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Affiliation(s)
- G A Mauser
- Faculty of Business Administration, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada
| | - M Margolis
- Department of Political Science, University of Cincinnati, Cincinnati, OH 45221-0375, USA
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Schuenemeyer J, Hong Y, Plankey M, Allen M, Margolis M, Johnson L, De Marchi L, Marshall M. F-106ENTRAPMENT OF FOREIGN BODIES DURING THORACIC SURGERY. Interact Cardiovasc Thorac Surg 2016. [DOI: 10.1093/icvts/ivw260.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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18
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Hynes CF, Seevaratnam S, Gesuwan K, Margolis M, Marshall MB. The efficacy of oral anticholinergics for sympathetic overactivity in a thoracic surgery clinic. J Thorac Cardiovasc Surg 2016; 152:565-8. [PMID: 27160942 DOI: 10.1016/j.jtcvs.2016.03.092] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 03/03/2016] [Accepted: 03/13/2016] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Little is known of the success rates of oral anticholinergics for the treatment of primary hyperhidrosis and facial blushing as alternatives to surgical intervention. We examine predictors of success with these medications. METHODS A retrospective review was performed at a single institution, including all patients presenting with symptoms of primary hyperhidrosis, facial blushing, or both from 2004 to 2015. All patients were offered a trial of oral anticholinergics. If oral anticholinergic therapy was not successful, patients were offered surgery. Statistical analyses were performed to compare patients who declined surgery given the trial of oral anticholinergics with those who proceeded with surgery. RESULTS A total of 381 patients presented with symptoms of primary hyperhidrosis (86.6%), facial blushing (2.4%), or both (11.0%). A total of 230 patients (60.4%) declined surgery after using oral anticholinergics, and 151 patients (39.6%) chose surgery. Patients who declined surgery were more likely to have symptoms of primary hyperhidrosis without facial blushing (89.6% vs 82.1%; P = .02) or have primary symptoms involving the axilla, torso, scalp, or groin. Patients who proceeded with surgery had higher rates of palmar symptoms as a primary site (77.6% vs 61.1%; P = .01) and were more likely to have facial blushing alone or in combination with primary hyperhidrosis. Presentation with palmar symptoms and greater number of prior therapy attempts were independent predictors of proceeding with surgery after controlling for concomitant symptom type and location (P = .01 and P < .0001, respectively). CONCLUSIONS The majority of patients presenting with sympathetic overactivity decline surgery when a trial of oral anticholinergics is included in the treatment algorithm. Facial blushing and palmar symptoms were each associated with choosing surgery.
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Affiliation(s)
- Conor F Hynes
- Division of Thoracic Surgery, Georgetown University Hospital, Washington, DC
| | | | - Krisana Gesuwan
- Division of Thoracic Surgery, Georgetown University Hospital, Washington, DC
| | - Marc Margolis
- Division of Thoracic Surgery, Georgetown University Hospital, Washington, DC
| | - M Blair Marshall
- Division of Thoracic Surgery, Georgetown University Hospital, Washington, DC.
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20
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Agarwal P, Fitelson D, Margolis M, Fleury C. Moldy Mold: A Story Untold. Chest 2014. [DOI: 10.1378/chest.1994664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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21
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Coveliers H, Meyer M, Gharagozloo F, Wisselink W, Rauwerda J, Margolis M, Tempesta B, Strother E. Robotic selective postganglionic thoracic sympathectomy for the treatment of hyperhidrosis. Ann Thorac Surg 2012; 95:269-74. [PMID: 23158099 DOI: 10.1016/j.athoracsur.2012.08.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 07/31/2012] [Accepted: 08/02/2012] [Indexed: 11/12/2022]
Abstract
BACKGROUND The surgical management of hyperhidrosis is controversial. Robotic surgical systems with their high-definition magnified 3-dimensional view and increased maneuverability in a confined space may facilitate the technique of selective sympathectomy (ramicotomy). We present a case series of patients undergoing selective postganglionic thoracic sympathectomy using robotic technology. METHODS This study is a case series analysis of patients who underwent selective postganglionic thoracic sympathectomy from July 2006 to November 2011. The operation was performed on a video-assisted thoracoscopic surgery (VATS) platform. The robot was used for pleural dissection and division of the postganglionic sympathetic fibers and the communicating rami. The success of sympathectomy was assessed by intraoperative temperature measurement of the ipsilateral upper extremity, patient interviews, and scoring of the symptomatic nature of hyperhidrosis based on the Hyperhidrosis Disease Severity Scale. RESULTS There were 110 sympathectomies performed in 55 patients (25 men, 30 women). Simultaneous bilateral sympathectomy was performed in all patients. Median age was 28 years (range, 16 to 65 years). There was no conversion to thoracotomy. Complications were minor and were seen in 5 of 55 patients (9%). There were no deaths. Median hospital stay was 1 day (range, 1 to 4 days). Of the 55 patients, 53 (96%) had sustained relief of their hyperhidrosis at a median follow-up of 24 months (range, 3 to 36 months), and compensatory sweating was seen in 4 patients (7.2%). CONCLUSIONS Robotic thoracoscopic selective sympathectomy is an effective, feasible, and safe procedure with excellent relief of hyperhidrosis and low rates of compensatory sweating and complications.
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Affiliation(s)
- Hans Coveliers
- Department of Vascular Surgery, VU University Medical Center, Amsterdam, The Netherlands
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Meyer M, Gharagozloo F, Tempesta B, Margolis M, Strother E, Christenson D. The learning curve of robotic lobectomy. Int J Med Robot 2012; 8:448-52. [DOI: 10.1002/rcs.1455] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2012] [Indexed: 01/02/2023]
Affiliation(s)
- Mark Meyer
- Washington Institute of Thoracic and Cardiovascular Surgery; George Washington University Medical Center; Washington DC USA
| | | | | | - Marc Margolis
- Washington Institute of Thoracic and Cardiovascular Surgery; George Washington University Medical Center; Washington DC USA
| | - Eric Strother
- University of Arizona College of Medicine; Tucson AZ USA
| | - Douglas Christenson
- Washington Institute of Thoracic and Cardiovascular Surgery; George Washington University Medical Center; Washington DC USA
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Meyer M, Gharagozloo F, Nguyen D, Tempesta B, Strother E, Margolis M. Robotic-assisted treatment of celiac artery compression syndrome: report of a case and review of the literature. Int J Med Robot 2012; 8:379-83. [DOI: 10.1002/rcs.1448] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2012] [Indexed: 01/07/2023]
Affiliation(s)
- Mark Meyer
- Washington Institute of Thoracic and Cardiovascular Surgery; The George Washington University Medical Center; Washington; DC; USA
| | - Farid Gharagozloo
- Washington Institute of Thoracic and Cardiovascular Surgery; The George Washington University Medical Center; Washington; DC; USA
| | - Duy Nguyen
- Washington Institute of Thoracic and Cardiovascular Surgery; The George Washington University Medical Center; Washington; DC; USA
| | - Barbara Tempesta
- Washington Institute of Thoracic and Cardiovascular Surgery; The George Washington University Medical Center; Washington; DC; USA
| | - Eric Strother
- Washington Institute of Thoracic and Cardiovascular Surgery; The George Washington University Medical Center; Washington; DC; USA
| | - Marc Margolis
- Washington Institute of Thoracic and Cardiovascular Surgery; The George Washington University Medical Center; Washington; DC; USA
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Gharagozloo F, Meyer M, Tempesta BJ, Margolis M, Strother ET, Tummala S. Robotic En Bloc First-Rib Resection for Paget-Schroetter Disease, a Form of Thoracic Outlet Syndrome Technique and Initial Results. Innovations 2012. [DOI: 10.1177/155698451200700107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Farid Gharagozloo
- Washington Institute of Thoracic and Cardiovascular Surgery, the George Washington University Medical Center, Washington, DC USA
| | - Mark Meyer
- Washington Institute of Thoracic and Cardiovascular Surgery, the George Washington University Medical Center, Washington, DC USA
| | - Barbara J. Tempesta
- Washington Institute of Thoracic and Cardiovascular Surgery, the George Washington University Medical Center, Washington, DC USA
| | - Marc Margolis
- Washington Institute of Thoracic and Cardiovascular Surgery, the George Washington University Medical Center, Washington, DC USA
| | - Eric T. Strother
- Washington Institute of Thoracic and Cardiovascular Surgery, the George Washington University Medical Center, Washington, DC USA
| | - Srini Tummala
- Reston Radiology Consultants, Reston Hospital, Reston, VA USA
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Gharagozloo F, Meyer M, Tempesta B, Strother E, Margolis M, Neville R. Proposed pathogenesis of Paget–Schroetter disease: impingement of the subclavian vein by a congenitally malformed bony tubercle on the first rib. J Clin Pathol 2011; 65:262-6. [DOI: 10.1136/jclinpath-2011-200479] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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26
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Kupershmidt M, Margolis M, Jang HJ, Massey C, Metser U. Evaluation of upper urinary tract tumors with portal venous phase MDCT: a case-control study. Int Braz J Urol 2011. [DOI: 10.1590/s1677-55382011000500020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- M Kupershmidt
- University Health Network; University of Toronto, Canada
| | - M Margolis
- University Health Network; University of Toronto, Canada
| | - HJ Jang
- University Health Network; University of Toronto, Canada
| | - C Massey
- University Health Network; University of Toronto, Canada
| | - U Metser
- University Health Network; University of Toronto, Canada
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Al-Mufarrej F, Margolis M, Tempesta B, Strother E, Gharagozloo F. Post-esophagectomy pseudomembranous inflammation of the interposed colon. Surg Infect (Larchmt) 2011; 11:479-81. [PMID: 20858162 DOI: 10.1089/sur.2008.098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Pseudomembranous colitis (PMC) usually is caused by antibiotic-related changes in colonic anaerobic microflora, leading to Clostridium difficile overgrowth and overproduction of toxins. We present the first reported case of PMC affecting the intrathoracic, interposed colon of an esophagectomy patient in the absence of inflammation of the in situ colon. METHODS Case report and review of pertinent English-language literature. CASE REPORT A 47 year-old male developed Clostridium difficile-related colitis after in Ivor-Lewis esophagectomy for carcinoma of the esophagus, and rendered asymptomatic after 10 days of therapy with oral vancomycin. Postoperatively, the patient developed a broncho-esophageal fistula, and was reconstructed with a two-stage colonic esophageal colonic interposition three months after the fistula was closed surgically. On postoperative day nine, the patient developed symptomatic PMC of the interposed colon segment, whereas the in situ colon was spared. Therapy with oral vancomycin for three weeks eradicated the infection. CONCLUSIONS Pseudomembranous colitismay develop in the interposed colon after a esophageal colonic interposition, even absent inflammation of the in situ colon. Previous infection with C. difficile may have increased the risk in this patient.
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Al-Mufarrej F, Margolis M, Tempesta B, Strother E, Gharagozloo F. Novel thoracoscopic approach to difficult posterior mediastinal tumors. Gen Thorac Cardiovasc Surg 2010; 58:636-9. [PMID: 21170634 DOI: 10.1007/s11748-009-0542-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2008] [Accepted: 09/03/2009] [Indexed: 10/18/2022]
Abstract
Thoracoscopic resection is the preferred treatment of posterior mediastinal tumors. However, thoracotomy may be necessary if the tumors are large or adherent; if they are demonstrate invasion or intraspinal growth; or if they are located in the superoposterior mediastinum or posterior costodiaphragmatic angle. We describe a case of a large, adherent posterior costodiaphragmatic mediastinal mass that would have been otherwise difficult to resect thoracoscopically if it were not for the three-dimensional visualization, greater dexterity, and accurate dissection offered by the Da Vinci robot.
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Affiliation(s)
- Faisal Al-Mufarrej
- The George Washington University Medical Center, 2300 Eye Street NW, Washington, DC 20037, USA.
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Gharagozloo F, Margolis M, Strother ET, Tempesta BJ. Robotic Laparoscopic Belsey Fundoplasty for Gastroesophageal Reflux Disease. Chest 2010. [DOI: 10.1378/chest.10513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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30
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Gharagozloo F, Margolis M, Strother E, Tempesta BJ. Intermediate-Term Follow-up in 175 Consecutive Robotic-Assisted Lobectomies for Early Stage Lung Cancer. Chest 2010. [DOI: 10.1378/chest.10505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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31
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Tempesta BJ, Margolis M, Strother ET, Gharagozloo F. Subpleural Infusion of Local Anesthetic for Pain Control After Thoracic Surgery. Chest 2010. [DOI: 10.1378/chest.10863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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32
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Margolis M, Gharagozloo F, Strother ET, Tempesta BJ. Robotics Changes the Approach to Diagnosis and Management of Mediastinal Masses. Chest 2010. [DOI: 10.1378/chest.10530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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33
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Tempesta BJ, Gharagozloo F, Strother ET, Margolis M. Robotic Thoracoscopic Heller Myotomy for Achalasia. Chest 2010. [DOI: 10.1378/chest.10516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Al-Mufarrej F, Margolis M, Tempesta B, Strother E, Gharagozloo F. Outpatient management of post-pneumonectomy and post-lobectomy empyema using the vacuum-assisted closure system. Surg Today 2010; 40:711-8. [DOI: 10.1007/s00595-008-4096-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Accepted: 10/30/2008] [Indexed: 10/19/2022]
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Abstract
Extramedullary hematopoiesis secondary to chronic anemia is well reported throughout the literature. A rare presentation of this condition is in the central nervous tissue reported most frequently as an epidural mass causing spinal cord compression. The authors report the case of a 51-year-old man with beta-thalassemia and chronic anemia who was found to have a 4-cm paravertebral mass suggestive of a schwannoma. The patient underwent transthoracic resection of the mass. Histological examination confirmed an extramedullary hematopoietic tumor. In this article the authors propose a method to distinguish extramedullary hematopoietic tumors from schwannomas. To the authors' knowledge, this is the first reported case in the neurosurgical literature of this phenomenon.
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Affiliation(s)
- Eric K Oermann
- Georgetown University School of Medicine, Washington, DC, USA
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Agrawal R, Margolis M, Reichner CA. AN UNUSUAL CAUSE OF ACUTE RESPIRATORY DISTRESS SYNDROME IN A POST THORACOTOMY PATIENT. Chest 2009. [DOI: 10.1378/chest.136.4_meetingabstracts.8s-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Al-Mufarrej F, Gharagozloo F, Tempesta B, Margolis M. Spontaneous cervicothoracolumbar pneumorrhachis, pneumomediastinum and pneumoperitoneum. The Clinical Respiratory Journal 2009; 3:239-43. [DOI: 10.1111/j.1752-699x.2008.00116.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Collins BT, Reichner CA, Collins SP, Oermann E, Vahdat S, Margolis M, Banovac F, Anderson ED. RADICAL STEREOTACTIC RADIOSURGERY (RSR) FOR INOPERABLE PATIENTS WITH PERIPHERAL STAGE IA NON-SMALL CELL LUNG CANCER (NSCLC): BASELINE POSTBRONCHODILATOR PERCENT PREDICTED FORCED EXPIRATORY VOLUME IN 1 SECOND (FEV1) CORRELATES WITH OVERALL SURVIVAL. Chest 2009. [DOI: 10.1378/chest.136.4_meetingabstracts.41s-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Massoumi A, Margolis M, Rosen J, Donnell AE. 29 YEAR OLD MALE WITH CHRONIC COUGH AND BRONCHIECTASIS. Chest 2009. [DOI: 10.1378/chest.136.4_meetingabstracts.29s-e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Al-Mufarrej F, Margolis M, Tempesta B, Strother E, Gharagozloo F. Robot-Assisted Thoracoscopic Resection of Intralobar Sequestration. J Laparoendosc Adv Surg Tech A 2009; 19:389-91. [DOI: 10.1089/lap.2008.0256] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Faisal Al-Mufarrej
- Department of Surgery, Division of Cardiothoracic Surgery, Washington Institute of Thoracic and Cardiovascular Surgery and The George Washington University Medical Center, Washington, DC
| | - Marc Margolis
- Department of Surgery, Division of Cardiothoracic Surgery, Washington Institute of Thoracic and Cardiovascular Surgery and The George Washington University Medical Center, Washington, DC
| | - Barbara Tempesta
- Department of Surgery, Division of Cardiothoracic Surgery, Washington Institute of Thoracic and Cardiovascular Surgery and The George Washington University Medical Center, Washington, DC
| | - Eric Strother
- Department of Surgery, Division of Cardiothoracic Surgery, Washington Institute of Thoracic and Cardiovascular Surgery and The George Washington University Medical Center, Washington, DC
| | - Farid Gharagozloo
- Department of Surgery, Division of Cardiothoracic Surgery, Washington Institute of Thoracic and Cardiovascular Surgery and The George Washington University Medical Center, Washington, DC
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Al-Mufarrej F, Margolis M, Strother E, Tempesta B, Gharagozloo F. Bronchial stump reinforcement with an azygous vein flap. J Cardiothorac Surg 2009; 4:22. [PMID: 19476615 PMCID: PMC2696446 DOI: 10.1186/1749-8090-4-22] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2009] [Accepted: 05/28/2009] [Indexed: 11/16/2022] Open
Abstract
Bronchial stump reinforcement has been shown to significantly reduce the incidence of bronchopleural fistulas. Various coverage techniques have been described in the literature. While the azygous vein flap is an easy, safe and effective reinforcement option for right-sided bronchial stumps, the flap is not widely adopted, with little mention in the literature, partly due to surgeons' uneasiness with the technique. In this report, we describe an easy-to-adopt approach to azygous vein bronchial reinforcement.
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Affiliation(s)
- Faisal Al-Mufarrej
- The George Washington University Medical Center, Department of Surgery, 2300 Eye Street NW, Washington, DC 20037, USA.
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Al-Mufarrej F, Badar J, Gharagozloo F, Tempesta B, Strother E, Margolis M. Spontaneous pneumomediastinum: diagnostic and therapeutic interventions. J Cardiothorac Surg 2008; 3:59. [PMID: 18980688 PMCID: PMC2596119 DOI: 10.1186/1749-8090-3-59] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2008] [Accepted: 11/03/2008] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES The objective of this case series is to review our experience with spontaneous pneumomediastinum, review the available literature, and refine the current clinical approach to this uncommon condition. METHODS The case notes of all patients admitted to the George Washington University Medical Center with spontaneous pneumomediastinum from April 2005 to June 2008 were retrospectively reviewed, indentifying seventeen patients on whom various data was collected and analyzed. RESULTS The typical patient is a young man. The commonest presenting complaint is chest pain. Odynophagia and subcutaneous emphysema are common. Leucocytosis is uncommon. The need for swallow studies, antibiotics, and prolonged hospitalization is uncommon. Most patients have no recurrences or sequelae on long-term follow-up. CONCLUSION Spontaneous pneumomediastinum is an uncommon, self-limiting condition. Due to concerns for the integrity of the aero-digestive tract, the finding of spontaneous pneumomediastinum usually results in unnecessary radiological investigations, dietary restriction and antibiotic administration with prolonged hospitalization.
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Affiliation(s)
- Faisal Al-Mufarrej
- George Washington University Medical Center, Department of Surgery, Washington, DC 20037, USA.
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Al-Mufarrej F, Margolis M, Tempesta B, Strother E, Gharagozloo F. Novel thoracoscopic approach to posterior mediastinal goiters: report of two cases. J Cardiothorac Surg 2008; 3:55. [PMID: 18840297 PMCID: PMC2577642 DOI: 10.1186/1749-8090-3-55] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2008] [Accepted: 10/07/2008] [Indexed: 11/21/2022] Open
Abstract
Trans-cervical resection of posterior mediastinal goiters is usually very difficult, requiring a high thoracotomy. Until recently, using conventional video-assisted thoracoscopic surgery to resect such tumors has been technically difficult and unsafe. By virtue of 3 dimensional visualization, greater dexterity, and more accurate dissection, the Da Vinci robot, for the first time, enables a completely minimally invasive approach to the posterior superior mediastinum.
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Affiliation(s)
- Faisal Al-Mufarrej
- The George Washington University Medical Center, Department of Surgery, 2300 Eye Street N,W,, Washington, DC 20037, USA.
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Gharagozloo F, Margolis M, Strother E, Tempesta BJ. ROBOTIC LOBECTOMY FOR EARLY STAGE LUNG CANCER. Chest 2008. [DOI: 10.1378/chest.134.4_meetingabstracts.p73003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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45
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Tempesta BJ, Gharagozloo F, Margolis M, Strother E, Al-Mufarrej F. OUTPATIENT MANAGEMENT OF POSTPNEUMONECTOMY AND POSTLOBECTOMY EMPYEMA USING THE VAC SYSTEM. Chest 2008. [DOI: 10.1378/chest.134.4_meetingabstracts.p77002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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46
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Strother E, Gharagozloo F, Margolis M, Tempesta BJ. ROBOT-ASSISTED THORACOSCOPIC RESECTION OF BRONCHOGENIC CYSTS: VIDEO PRESENTATION OF ROBOT POSITIONING AND OPERATIVE PROCEDURE. Chest 2008. [DOI: 10.1378/chest.134.4_meetingabstracts.p81002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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47
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Gharagozloo F, Margolis M, Strother E, Tempesta BJ. PREVENTION OF BRONCHIAL STUMP FISTULA WITH THE USE OF VASCULARIZED PEDICLE MUSCLE FLAP OF THE DIAPHRAGM. Chest 2008. [DOI: 10.1378/chest.134.4_meetingabstracts.p82004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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48
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Gharagozloo F, Margolis M, Strother E, Tempesta B. ROBOT-ASSISTED THORACOSCOPIC RIGHT UPPER LOBECTOMY FOR EARLY STAGE LUNG CANCER – VIDEO PRESENTATION OF ROBOT POSITIONING AND OPERATIVE TECHNIQUE. Chest 2008. [DOI: 10.1378/chest.134.4_meetingabstracts.s12004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Strother E, Gharagozloo F, Tempesta BJ, Margolis M. ROBOTIC TRANSABDOMINAL BELSEY FUNDOPLASTY FOR GASTROESOPHAGEAL REFLUX DISEASE. Chest 2008. [DOI: 10.1378/chest.134.4_meetingabstracts.p81001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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