Invasive Mechanical Ventilation

Invasive mechanical ventilation is a potentially lifesaving intervention for acutely ill patients. The goal of this review is to provide a concise, clinically focused overview of basic invasive mechanical ventilation for the many clinicians who care for mechanically ventilated patients. Attention is given to how common ventilator modes differ in delivering a mechanical breath, evaluation of respiratory system mechanics, how to approach acute...

Protocol to Improve Genotyping of Non-Small-Cell Lung Cancer Diagnosed Using EBUS-TBNA

Objectives: Targeted therapies for non-small-cell lung cancers (NSCLCs) are based on the presence of driver mutations such as epidermal growth factor receptor (EGFR) and the echinoderm microtubule-associated protein-like 4-anaplastic lymphoma kinase (EML4-ALK) translocation. Endobronchial ultrasound-guided-transbronchial needle aspiration (EBUS-TBNA) is a first-line modality for diagnosing and staging NSCLC. A quality improvement protocol...

Major Complications Associated with Conventional Transbronchial Needle Aspiration

Objectives: Transbronchial needle aspiration (TBNA) is a widely used sampling technique for diagnosis and staging of lesions centered around bronchoscopically accessible airways. We report our single-institution experience of complications associated with conventional TBNA (C-TBNA) performed in 606 consecutive cases. Methods: Electronic medical records with bronchoscopy log data of C-TBNAs performed from January 2003 to December 2016 were...

Commentary on “Major Complications Associated with Conventional Transbronchial Needle Aspiration”

In this issue of the Southern Medical Journal, Zaman and Shrestha1 provide a retrospective on their 14 years of experience with the major complications associated with conventional transbronchial needle aspiration (TBNA) and an extensive review of the published literature in the field. They make recommendations based on the available evidence regarding the approaches that physicians should use to prevent, whenever possible, these...

Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration Use for Subclassification and Genotyping of Lung Non-Small-Cell Carcinoma

Objectives: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the primary method for the diagnosis and staging of lung cancer. The purpose of this study was to assess the yield of EBUS-TBNA in the subtyping and genotyping of lung adenocarcinoma. Methods: Sixty-nine patients at Indiana University Hospital and Sidney and Lois Eskenazi Hospital with possible or confirmed lung adenocarcinoma underwent EBUS-TBNA using...

Innovative Technique for Endoscopic Placement of Sengstaken-Blakemore Tube

Objectives: The Sengstaken-Blakemore (SB) tube is used in cases of uncontrolled variceal bleeding. Because of the complexity of the procedure and the lack of visualization, various techniques have been described to avoid blind placement. We report an innovative and simple technique for placement of the SB tube under direct endoscopic visualization. Methods: A grasp-and-place technique for endoscopic placement of SB tubes is described and a...

Risk Factors for Failure in Complicated Intraabdominal Infections

Objectives: Approximately 20% of patients with complicated intraabdominal infections (cIAIs) fail therapy. The purpose of this study was to identify risk factors for clinical failure in patients with cIAIs. Methods: International Classification of Diseases, Ninth Revision codes for cIAIs were obtained to identify patients. Adult patients who received at least 48 hours of intravenous antibiotics were included. Patients were chronologically...

Commentary on “Development and Implementation of an Inpatient Otolaryngology Consultation Service at an Academic Medical Center”

Stewart and colleagues should be commended for their article in this issue of the Southern Medical Journal, which attempts to shed light on many unanswered questions regarding the roles of an inpatient consult service and advanced practice providers (APPs) in an academic...

Development and Implementation of an Inpatient Otolaryngology Consultation Service at an Academic Medical Center

Objectives: To design and implement a formal otolaryngology inpatient consultation service that improves satisfaction of consulting services, increases educational opportunities, improves the quality of patient care, and ensures sustainability after implementation. Methods: This was a retrospective cohort study in a large academic medical center encompassing all inpatient otolaryngology service consultations from July 2005 to June...

Multidisciplinary Perioperative Management of Pulmonary Arterial Hypertension in Patients Undergoing Noncardiac Surgery

Objectives: To describe the effect of implementing a contemporary perioperative pulmonary hypertension (PH)–targeted protocol in patients with pulmonary arterial hypertension (PAH) undergoing noncardiac surgery (NCS). Methods: The data of consecutive patients with PAH diagnosed by right heart catheterization who underwent NCS between January 1, 2006 and February 9, 2016 were reviewed. Patient demographics, etiology of PAH, clinical...

Femorofemoral Crossover Bypass Graft Has Excellent Patency When Performed with EVAR for AAA with UIOD

Objectives: To compare the durability of the crossover femorofemoral bypass graft (CFFBG) in combination with aorto-uni-iliac stent graft (AUIS) for abdominal aortic aneurysm with the durability of CFFBG used in the treatment of unilateral iliac occlusive disease (UIOD). Methods: We analyzed the clinical records of 69 patients who underwent CFFBG from 1992 until 2010. Group I consisted of 34 patients who received CFFBGs in combination with...

Nontraumatic Emergency Laparotomy: Surgical Principles Similar to Trauma Need to Be Adopted?

Objectives: In 2011, the Royal College of Surgeons published Emergency Surgery: Standards for Unscheduled Care in response to variable clinical outcomes for emergency surgery. The purpose of this study was to examine whether different treatment modalities would alter survival. Methods: All patients who underwent emergency laparotomy between April 2011 and December 2012 at Warwick Hospital (Warwick, UK) were included retrospectively....

Comorbidity Is a Competing Factor for Disease Recurrence Postnephrectomy

Objective: There is a relation between tumor stage and grade with the risk of cancer recurrence in patients undergoing surgical treatment for kidney cancer. The association of patient comorbidity with disease recurrence is less well characterized. The objective of this study was to explore the association between comorbidity and the recurrence of kidney cancer. Methods: We performed a retrospective analysis of 263 patients who received a...

Video-Assisted Thoracoscopic versus Open Lobectomy: Costs and Outcomes

Objectives: Video-assisted thoracoscopic (VATS) lobectomy is considered a promising surgical therapy for the diagnosis and treatment of non–small-cell lung carcinoma. The issue of whether VATS is superior to open thoracotomy remains controversial, however. We sought to determine whether the use of VATS lobectomy for diagnosing and treating non–small-cell lung carcinoma would improve patient outcomes at our institution. Methods: A...

PROMISE of Coronary CT Angiography: Precise and Accurate Diagnosis and Prognosis in Coronary Artery Disease

Coronary computed tomography angiography (CCTA) is a rapidly growing and powerful diagnostic test that offers a great deal of precision with respect to diagnosing coronary artery disease (CAD). Guideline statements for patients with stable ischemic heart disease have recommended CCTA for only a limited portion of intermediaterisk patients who have relative or absolute contraindications for exercise or vasodilator stress testing. The publication...

A Multidisciplinary Approach to Castleman Disease of the Neck

Castleman disease (CD) is a rare lymphoproliferative disorder that occurs in adults and rarely in the pediatric population. The disease is characterized by slowly enlarging masses that can form anywhere within the lymphatic system. It is an uncommon cause of a neck mass in both children and adults that presents insidiously and nonspecifically. A 21-year-old woman was referred to the otolaryngology service because of an asymptomatic neck mass...

Multidisciplinary Clinical Case Study

This issue of the Southern Medical Journal (SMJ) introduces a new format for case reports that emphasizes and requires multidisciplinary and interprofessional content. After a 5-year moratorium on unidimensional and single specialty case reports, we believe that the multidisciplinary clinical case study format will align with the Journal’s mission as a broad-based, interprofessional, clinically focused educational journal. Because the...

The View from Outside

More than a decade ago I retired from the active practice of medicine. I’d spent 26 years in solo private practice, then 10 as a professor at a well-known teaching medical center. Before that came 4 years in medical school, 4 years in specialty training, and almost 3 years as a medical officer in the US Air Force. Medicine had been my life for almost half a century. And now it wasn’t. Talk about culture...

Systematic Review and Meta-Analysis of Major Cardiovascular Outcomes for Radial Versus Femoral Access in Patients With Acute Coronary Syndrome

Objectives: Radial artery access (RA) for left heart catheterization and percutaneous coronary interventions (PCIs) has been demonstrated to be safe and effective. Despite consistent data showing less bleeding complications compared with femoral artery access (FA), it continues to be underused in the United States, particularly in patients with acute coronary syndrome (ACS) in whom aggressive anticoagulation and platelet inhibition regimens are...

Risk Factors for Complications during Outpatient Parenteral Antimicrobial Therapy for Adult Orthopedic and Neurosurgical Infections

Objectives: Outpatient parenteral antimicrobial therapy (OPAT) is an effective way of treating infections, but complications are common. We identified patient characteristics and OPAT treatment factors associated with increased risk of OPAT-related complications. Methods: We used a retrospective cohort design that assessed 337 adult patients treated with OPAT for orthopedic and neurosurgical infections between August 1, 2008 and May 30, 2010....