Our objective was to evaluate whether the number and volume of surgical lung biopsies (SLB) influ... more Our objective was to evaluate whether the number and volume of surgical lung biopsies (SLB) influence the diagnosis of diffuse interstitial lung disease (ILD). Retrospective study of SLB for suspected ILD in patients from the Mayo Clinic from January 2002 to January 2010. Data were collected in the institution and analyzed. 311 patients were studied. Mean number of biopsies was 2.05 (SD 0.6); 1 biopsy in 50 (16%), 2 in 198 (63.7%), 3 in 59 (19%) and 4 in 4 (1.3%). Histopathologic diagnosis was: definitive (specific): 232 (74.6%), descriptive (non-specific): 76 (24.4%), no diagnosis: 3 (1%). After excluding patients without diagnosis (n=3), there were 50 patients with only 1 biopsy, 196 with 2 and 62 with 3 or 4; the definitive diagnostic yield was similar in all 3 groups (37/50; 74%, 150/196; 77%, and 45/62; 73%) (Chi-square, p value 0.8). The propensity score analysis between patients with 1 SLB and patients with more than 1 SLB also showed no difference in diagnostic yield. Regard...
RESUMEN Presentamos un caso de hipo incoercible de cuatro años de duración y con clínica de pérdi... more RESUMEN Presentamos un caso de hipo incoercible de cuatro años de duración y con clínica de pérdida de peso y fatiga. Refractario al tratamiento médico. Se le implantó un marcapasos diafragmático por vía intratorácica. Este aparato controla los movimientos del diafragma por estimulación eléctrica del nervio frénico. Se consiguió con ello disminuir la intensidad de los episodios de hipo. Este
Interactive cardiovascular and thoracic surgery, 2006
We report our experience with a policy of early chest tube removal after video-assisted thoracic ... more We report our experience with a policy of early chest tube removal after video-assisted thoracic surgical lung biopsy (VATS-LB) in 146 patients. The chest tube (24F) was removed if four conditions were met: immediate extubation, complete expansion of the lung, drainage <100 ml/h and absence of an air leak. VATS-LB was performed on 160 patients. In 146 (91.2%) early chest tube removal was feasible. Fourteen (8.8%) were too ill to be included in this program. The chest tube was removed in 135 patients (92.4%) less than one hour after. In nine patients (6.2%) it was removed 4-24 h after, due to initial air-leak. In only two cases (1.4%) was the tube removed later. Median hospital stay was 1.2 days (range: 0-7). There were 32 outpatient procedures since 2001 (50% of VATS-LB in this period). Postoperative hemothorax occurred in two patients (1.4%) and pneumothorax in three (2.0%). Three of the five required readmission (2%). Three patients died in the hospital due to the progression o...
Objetivo. Valorar los resultados y complicaciones de la simpaticotomía torácica videotoracoscópic... more Objetivo. Valorar los resultados y complicaciones de la simpaticotomía torácica videotoracoscópica (VATS) en el tratamiento de los pacientes diagnostica-dos de rubor facial incontrolable y/o hiperhidrosis fa-cial. Pacientes y método. Entre mayo de 2000 y agosto de 2006, llevamos a cabo 82 ...
In summary, from the different alternatives to conventional hospitalization developed in the last... more In summary, from the different alternatives to conventional hospitalization developed in the last decades, outpatient surgery has been the one with the greatest growth. However, only few studies have been reported on thoracic surgery and there is still great potential for an increase in outpatient thoracic surgery. The aim of this article has been to evaluate the clinical aspects, results, and economical impact of an outpatient thoracic surgery program (OTSP). Video-assisted mediastinoscopy, lung biopsy, and bilateral thoracic sympathectomy can be accomplished safely in a significant percentage of cases as ambulatory patients. The impact of the economical benefit of outpatient thoracic surgical program over the conventional hospitalization depends on the previous department&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s policy on hospital stay. Further experience is needed to increase the substitution index and expand the OTSP to other procedures.
The aim of this study was to investigate the yield of cervical mediastinoscopy (CM) for pathologi... more The aim of this study was to investigate the yield of cervical mediastinoscopy (CM) for pathologically diagnosed non-small cell lung cancer (NSCLC), with respect to lymph node size on computed tomography (CT), cell type, and the location of the primary tumor. We reviewed 142 patients who underwent standard cervical mediastinoscopy from April of 1994 to June of 2003 for pathologically diagnosed NSCLC. The staging yield was determined by the percentage of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;positive&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; CM (metastatic paratracheal or subcarinal nodes). Mediastinoscopy was performed when the lymph node diameter was &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;1 cm and, since 2001, whenever paratracheal or subcarinal lymph nodes were clearly seen on CT, regardless of size. Group A includes patients with lymph nodes on CT of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or =1 cm. Group B includes patients with lymph nodes of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;1 cm. The chi test was used for statistical analysis. We performed CM on 142 patients. There were 127 men (89.4%) and 15 women (10.6%). The mean age of the patients was 64.7 years (range, 38-83). The global yield was 28.2% (CM positive in 40 of 142 cases). The specific yield by groups was as follows, with respect to lymph node size: group A (lymph nodes &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;1 cm), 37.9%, and group B (lymph nodes &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;1 cm), 8.5% (p…
Our objective was to evaluate whether the number and volume of surgical lung biopsies (SLB) influ... more Our objective was to evaluate whether the number and volume of surgical lung biopsies (SLB) influence the diagnosis of diffuse interstitial lung disease (ILD). Retrospective study of SLB for suspected ILD in patients from the Mayo Clinic from January 2002 to January 2010. Data were collected in the institution and analyzed. 311 patients were studied. Mean number of biopsies was 2.05 (SD 0.6); 1 biopsy in 50 (16%), 2 in 198 (63.7%), 3 in 59 (19%) and 4 in 4 (1.3%). Histopathologic diagnosis was: definitive (specific): 232 (74.6%), descriptive (non-specific): 76 (24.4%), no diagnosis: 3 (1%). After excluding patients without diagnosis (n=3), there were 50 patients with only 1 biopsy, 196 with 2 and 62 with 3 or 4; the definitive diagnostic yield was similar in all 3 groups (37/50; 74%, 150/196; 77%, and 45/62; 73%) (Chi-square, p value 0.8). The propensity score analysis between patients with 1 SLB and patients with more than 1 SLB also showed no difference in diagnostic yield. Regard...
RESUMEN Presentamos un caso de hipo incoercible de cuatro años de duración y con clínica de pérdi... more RESUMEN Presentamos un caso de hipo incoercible de cuatro años de duración y con clínica de pérdida de peso y fatiga. Refractario al tratamiento médico. Se le implantó un marcapasos diafragmático por vía intratorácica. Este aparato controla los movimientos del diafragma por estimulación eléctrica del nervio frénico. Se consiguió con ello disminuir la intensidad de los episodios de hipo. Este
Interactive cardiovascular and thoracic surgery, 2006
We report our experience with a policy of early chest tube removal after video-assisted thoracic ... more We report our experience with a policy of early chest tube removal after video-assisted thoracic surgical lung biopsy (VATS-LB) in 146 patients. The chest tube (24F) was removed if four conditions were met: immediate extubation, complete expansion of the lung, drainage <100 ml/h and absence of an air leak. VATS-LB was performed on 160 patients. In 146 (91.2%) early chest tube removal was feasible. Fourteen (8.8%) were too ill to be included in this program. The chest tube was removed in 135 patients (92.4%) less than one hour after. In nine patients (6.2%) it was removed 4-24 h after, due to initial air-leak. In only two cases (1.4%) was the tube removed later. Median hospital stay was 1.2 days (range: 0-7). There were 32 outpatient procedures since 2001 (50% of VATS-LB in this period). Postoperative hemothorax occurred in two patients (1.4%) and pneumothorax in three (2.0%). Three of the five required readmission (2%). Three patients died in the hospital due to the progression o...
Objetivo. Valorar los resultados y complicaciones de la simpaticotomía torácica videotoracoscópic... more Objetivo. Valorar los resultados y complicaciones de la simpaticotomía torácica videotoracoscópica (VATS) en el tratamiento de los pacientes diagnostica-dos de rubor facial incontrolable y/o hiperhidrosis fa-cial. Pacientes y método. Entre mayo de 2000 y agosto de 2006, llevamos a cabo 82 ...
In summary, from the different alternatives to conventional hospitalization developed in the last... more In summary, from the different alternatives to conventional hospitalization developed in the last decades, outpatient surgery has been the one with the greatest growth. However, only few studies have been reported on thoracic surgery and there is still great potential for an increase in outpatient thoracic surgery. The aim of this article has been to evaluate the clinical aspects, results, and economical impact of an outpatient thoracic surgery program (OTSP). Video-assisted mediastinoscopy, lung biopsy, and bilateral thoracic sympathectomy can be accomplished safely in a significant percentage of cases as ambulatory patients. The impact of the economical benefit of outpatient thoracic surgical program over the conventional hospitalization depends on the previous department&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s policy on hospital stay. Further experience is needed to increase the substitution index and expand the OTSP to other procedures.
The aim of this study was to investigate the yield of cervical mediastinoscopy (CM) for pathologi... more The aim of this study was to investigate the yield of cervical mediastinoscopy (CM) for pathologically diagnosed non-small cell lung cancer (NSCLC), with respect to lymph node size on computed tomography (CT), cell type, and the location of the primary tumor. We reviewed 142 patients who underwent standard cervical mediastinoscopy from April of 1994 to June of 2003 for pathologically diagnosed NSCLC. The staging yield was determined by the percentage of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;positive&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; CM (metastatic paratracheal or subcarinal nodes). Mediastinoscopy was performed when the lymph node diameter was &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;1 cm and, since 2001, whenever paratracheal or subcarinal lymph nodes were clearly seen on CT, regardless of size. Group A includes patients with lymph nodes on CT of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or =1 cm. Group B includes patients with lymph nodes of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;1 cm. The chi test was used for statistical analysis. We performed CM on 142 patients. There were 127 men (89.4%) and 15 women (10.6%). The mean age of the patients was 64.7 years (range, 38-83). The global yield was 28.2% (CM positive in 40 of 142 cases). The specific yield by groups was as follows, with respect to lymph node size: group A (lymph nodes &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;1 cm), 37.9%, and group B (lymph nodes &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;1 cm), 8.5% (p…
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