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Journal and News Scan
January 6, 2016
Submitted by: Arie Blitz
Are we removing enough pericardial fluid to allow a diagnosis of malignant effusion? The authors reviewed 480 pericardiocentesis specimens by comparing the percentage of malignant diagnoses ("malignancy fraction") by the volume submitted for analysis. Using pericardial biopsy as the standard, the sensitivity for the diagnosis of malignancy was 18.1% vs. 10.6% if more or less than 60 mL was submitted, respectively. These results beg the following questions: 1. Did patients with pericardial malignancies tend to have larger effusions and therefore larger aspirations? 2. Was more fluid aspirated or submitted in patients with a higher index of suspicion for malignancy?
January 4, 2016
Submitted by: Mark Ferguson
This retrospective single-center study evaluated outcomes of patients treated for flail chest using open reduction and fixation (ORIF) or non-operative management (NOM). The 41 ORIF and 45 NOM patients were similar in demographics and injury severity. Hospital and ICU LOS were longer in the ORIF group. The ORIF group also trended towards longer time on the ventilator. Further knowledge regarding appropriate patient selection criteria for ORIF in the management of flail chest is needed.
December 28, 2015
Submitted by: Lisa Brown
The goal of this study was to present the changes in pulmonary function after SBRT in 127 patients with clinical stage I NSCLC or a single lung metastasis. These patients were either too high risk for an operation or preferred a non-operative treatment approach. PFTs were measured at several time points including within 10 weeks of starting SBRT and then 6 weeks, 3 months, 6 months, 9 months, 1 year and 2 years after treatment (median follow-up was 25 months). At 12 months, there were significant decreases in TLC (-3.6%), FVC (-5.7%), FVC % predicted (-4.6%), FEV1 (-4.1%), and corrected DLCO (-5.2%) compared to baseline. At 24 months, there were significant decreases in FVC (-8.9%), and FEV1 (-7.6%) compared to baseline. When compared to surgical series, the reductions in lung function appear later and are smaller.
December 27, 2015
Submitted by: Arie Blitz
The authors tested a group of 176 patients undergoing cardiac surgery for dysphagia both preoperatively and postoperatively. Preoperatively, 8.5% of patients failed the swallow test. Postoperatively, 21.6% failed the test. All patients who failed preoperatively also failed postoperatively. Thus, approximately 40% fo patients who have postop dysphagia had evidence of dysphagia preoperatively.
These results beg the question: Ought we to be screening at-risk patients for dysphagia preoperatively? If so, how would this change management postop?
December 26, 2015
Submitted by: Arie Blitz
Using CMS CABG data as a denominator, the investigators examined the penetration, completeness, and representativeness of the STS database with respect to the CMS database. The investigators found that, in 2012--the most recent year analyzed--center-level penetration was 90% and patient-level penetration was 94%. These penetrations have increased substantially since 2000. By linking the two databases, a robust synergy may be created that will provide a powerful tool for analyzing long-term outcomes and costs for cardiothoracic surgery.
December 24, 2015
Submitted by: Mark Ferguson
Whether postoperative adjuvant therapy for node-positive residual disease after induction therapy and resection for esophageal cancer is unknown. This single institution study identified 101 node positive patients among 764 treated with induction therapy and surgery during 2000-2012. 45 of 101 patients who underwent adjuvant therapy, primarily chemotherapy were compared to the 56 patients who received no additional therapy. Median survival was better in the adjuvant group, 24 vs 18 mos (p=0.033). Determinants of survival were adjuvant therapy, hospital length of stay, and number of affected nodes.
December 24, 2015
Submitted by: Mark Ferguson
The impact of combined mitral stenosis and aortic atresia on outcomes of Norwood procedures for hypoplastic left heart syndrome was examined in a single institution. The incidence among 74 operated patients was 19%. Mortality for affected patients was 29% vs 7% for the other patients. The mechanism of mortality appeared to be myocardial ischemia. Preoperative angiography did not assist in risk-stratifying patients.
December 24, 2015
Submitted by: Mark Ferguson
Patients undergoing surgical ablation for afib were evaluated for recurrence using either intermittent monitoring using traditional methods or continuous monitoring using an implantable loop recorder (ILR). Compliance with ILR use was higher than with traditional monitoring methods (93% vs about 80%). Detection of afib was similar between ILR and traditional methods. Few symptomatic events actually represented afib.
December 24, 2015
Submitted by: Mark Ferguson
With the successful linking of the STS Adult Cardiac Surgery Database and the Centers for Medicare and Medicaid (CMS) database, the authors studied the extent to which the STS database represents national activity in CABG. The number of centers represented increased from 45% in 2000 to 90% in 2012. The number of CABG patients represented increased from 51% to 94% during the same period. The number of CABG patients operated on at STS sites and registered in the STS database increased from 88% to 98%.
December 23, 2015
Submitted by: Mark Ferguson
Intermediate term results of a single institution experience with POEM for management of achalasia are reported for the first 100 cases. Most patients were women (59%) and the overall mean age was 48 years. POEM was successfully completed in 94 pts and without complications. Clinical success was declared in 94.5%, although pH studies documented abnormal esophageal acid exposure in 53% of patients postoperatively and 24% of patients complained of heartburn.