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Article ; Online: Hemoptysis is frequently fatal if blood comes directly from the aorta commentary.

Szewczyk, Joanne B / Villamizar, Nestor R / Nguyen, Dao M

2020 Volume 36, Issue 1, Page(s) 162–164

Abstract: Physicians throughout the world, across various specialties, are faced with diagnostic challenges of appropriately identifying the source of hemotosysis, which could range from a simple treatable infection, to the more ominous massive hemorrhage from the ...

Abstract	Physicians throughout the world, across various specialties, are faced with diagnostic challenges of appropriately identifying the source of hemotosysis, which could range from a simple treatable infection, to the more ominous massive hemorrhage from the aorta requiring emergency, life saving surgery. Aortobronchopulmonary fistula, which is an abnormal communication between the thoracic aorta and the pulmonary tree, is an uncommon but often lethal condition if not promptly surgically intervened. Over the decades, the underlying cause has shifted, from primarily due to an aortic infection, such as tuberculosis, to now secondarily as a result of endovascular repair of the intrathoracic aorta. The best treatment modality, whether open surgical repair, endovascular management, or hybrid approach continues to be debated given the high operative morbidity and mortality of open repair and need to address the pulmonary communication, with optimal management still undetermined.
MeSH term(s)	Aorta/surgery ; Aorta, Thoracic/diagnostic imaging ; Aorta, Thoracic/surgery ; Blood Vessel Prosthesis Implantation ; Endovascular Procedures ; Fistula ; Hemoptysis/etiology ; Humans ; Treatment Outcome
Language	English
Publishing date	2020-11-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	639059-6
ISSN	1540-8191 ; 0886-0440
ISSN (online)	1540-8191
ISSN	0886-0440
DOI	10.1111/jocs.15126
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Zs.A 2221: Show issues

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bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
Jg. 1995 - 2021: Lesesall (1.OG)
ab Jg. 2022: Lesesaal (EG)

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Article: Endobronchial valves: a bridge to definitive surgical management in COVID-19 recurrent pneumothorax.

Szewczyk, Joanne / Adkinson, Brian Cody / Akkineni, Sisir / Nguyen, Dao M / Arias, Sixto A / Villamizar, Nestor R

Journal of thoracic disease

2021 Volume 13, Issue 1, Page(s) 411–413

Language	English
Publishing date	2021-01-16
Publishing country	China
Document type	Journal Article
ZDB-ID	2573571-8
ISSN	2077-6624 ; 2072-1439
ISSN (online)	2077-6624
ISSN	2072-1439
DOI	10.21037/jtd-20-3248
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Article ; Online: Large mediastinal schwannoma with great vessel encroachment requiring vascular reconstruction: a case report.

Szewczyk, Joanne B / Hachey, Krista / Rey, Jorge / Nguyen, Dao M / Villamizar, Nestor R

Mediastinum (Hong Kong, China)

2021 Volume 5, Page(s) 37

Abstract: The most common posterior mediastinal masses are neurogenic tumors such as peripheral nerve sheath tumors (PNST). Schwannomas, a subtype of PNST, are most often benign, well encapsulated tumors of neural crest cell origin, and are frequently incidentally ...

Abstract	The most common posterior mediastinal masses are neurogenic tumors such as peripheral nerve sheath tumors (PNST). Schwannomas, a subtype of PNST, are most often benign, well encapsulated tumors of neural crest cell origin, and are frequently incidentally found, ranging in size from small asymptomatic mediastinal tumors to large masses. Rarely, large schwannomas are discovered when symptoms develop due to compression or involvement of nearby structures leading to an array of possible sequela which can include, but not limited to, persistent cough, hemoptysis, and dysphagia. Management decisions are based off of tumor size, location, concern for underlying malignant pathology, and potential for complications related to tumor invasion of vital anatomical structures. A majority of the schwannomas undergo surgical resection, though a subset of small, asymptomatic, benign tumors on imaging or pathology may be managed with surveillance. This case report describes a large posterior mediastinal schwannoma adherent to the posterior aortic arch and encasing the left subclavian and vertebral arteries. Surgical resection required vascular resection of a segment of the left subclavian artery and graft reconstruction using polytetrafluoroethylene (PTFE). This report further highlights the importance of preoperative planning with consideration of a multidisciplinary approach in preparation for resection of large, complex posterior mediastinal masses.
Language	English
Publishing date	2021-12-25
Publishing country	China
Document type	Case Reports
ISSN	2522-6711
ISSN (online)	2522-6711
DOI	10.21037/med-20-71
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Article ; Online: Incidence of postprocedural coronavirus disease 2019 (COVID-19) at an urban academic medical center.

Szewczyk, Joanne B / Nguyen, Dao M / Warde, Prem R / Shukla, Bhavarth / Ferreira, Tanira / Gershengorn, Hayley B

Infection control and hospital epidemiology

2021 Volume 42, Issue 10, Page(s) 1279–1281

MeSH term(s)	Academic Medical Centers ; COVID-19 ; Humans ; Incidence ; SARS-CoV-2
Language	English
Publishing date	2021-05-05
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	639378-0
ISSN	1559-6834 ; 0195-9417 ; 0899-823X
ISSN (online)	1559-6834
ISSN	0195-9417 ; 0899-823X
DOI	10.1017/ice.2021.191
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Zs.A 1714: Show issues

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Je nach Verfügbarkeit (siehe Angabe bei Bestand)
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Jg. 1995 - 2021: Lesesall (1.OG)
ab Jg. 2022: Lesesaal (EG)

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Article ; Online: Effect of COVID-19 on the delivery of care for thoracic surgical patients.

Nguyen, Dao M / Kodia, Karishma / Szewczyk, Joanne / Alnajar, Ahmed / Stephens-McDonnough, Joy A / Villamizar, Nestor R

JTCVS open

2022 Volume 10, Page(s) 456–468

Abstract: Objective: In this study we aimed to determine the effect of the COVID-19 pandemic on the delivery of care for thoracic surgical patients at an urban medical center.: Methods: A retrospective analysis of all thoracic surgical cases from May 1, 2019, ... ...

Abstract	Objective: In this study we aimed to determine the effect of the COVID-19 pandemic on the delivery of care for thoracic surgical patients at an urban medical center. Methods: A retrospective analysis of all thoracic surgical cases from May 1, 2019, to December 31, 2020, was conducted. Demographic characteristics, preoperative surgical indications, procedures, final pathologic diagnoses, and perioperative outcomes were recorded. A census of operative cases, relevant ancillary services, and outpatient thoracic clinics were obtained from our institutional database. Results: Six hundred nineteen cases were included in this study (329 pre-COVID-19 and 290 COVID-19, representing an 11.8% reduction). There were no differences in type of thoracic procedures or perioperative outcomes among the 2 cohorts. Prolonged reduction of thoracic surgical cases (50% of baseline) during the first half of the COVID-19 period was followed by a resurgence of surgical volumes to 110% of baseline in the second half. A similar incidence of cases were performed for oncologic indications during the first half whereas more benign cases were performed in the second half, coinciding with the launch of our robotic foregut surgery program. After undergoing surgery during the pandemic, none of our patients reported COVID-19 symptoms within 14 days of discharge. Conclusions: During the initial surge of COVID-19, while there was temporary closure of operative services, our health care system continued to provide safe care for thoracic surgery patients, particularly those with oncologic indications. Since phased reopening, we have experienced a rebound of surgical volume and case mix, ultimately mitigating the initial negative effect of the pandemic on delivery of thoracic surgical care.
Language	English
Publishing date	2022-02-17
Publishing country	Netherlands
Document type	Journal Article
ISSN	2666-2736
ISSN (online)	2666-2736
DOI	10.1016/j.xjon.2021.11.015
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Article ; Online: Optimization of an Enhanced Recovery After Surgery protocol for opioid-free pain management following robotic thoracic surgery.

Kodia, Karishma / Alnajar, Ahmed / Szewczyk, Joanne / Stephens-McDonnough, Joy / Villamizar, Nestor R / Nguyen, Dao M

JTCVS open

2022 Volume 9, Page(s) 317–328

Abstract: Objectives: Our Enhanced Recovery After Thoracic Surgery protocol was implemented on February 1, 2018, and firmly established 7 months later. We instituted protocol modifications on January 1, 2020, aiming to further reduce postoperative opioid ... ...

Abstract	Objectives: Our Enhanced Recovery After Thoracic Surgery protocol was implemented on February 1, 2018, and firmly established 7 months later. We instituted protocol modifications on January 1, 2020, aiming to further reduce postoperative opioid consumption. We sought to evaluate the influence of such efforts on clinical outcomes and the use of both schedule II and schedule IV opioids following robotic thoracoscopic procedures. Methods: A retrospective study of patients undergoing elective robotic procedures between September 1, 2018, and December 31, 2020, was conducted. Essential components of pain management in the original protocol included nonopioid analgesics, intercostal nerve blocks with long-acting liposomal bupivacaine diluted with normal saline, and opioids (ie, scheduled tramadol administration and as-needed schedule II narcotics). Protocol optimization included replacing saline diluent with 0.25% bupivacaine and switching tramadol to as needed, keeping other aspects unchanged. Demographic characteristics, type of robotic procedures, postoperative outcomes, and in-hospital and postdischarge opioids prescribed (ie, milligrams of morphine equivalent [MME]) were extracted from electronic medical records. Results: Three hundred twenty-four patients met the inclusion criteria (159 in the original and 183 in the optimized protocol). There was no difference in postoperative outcomes or acute postoperative pain; there was a significant reduction of in-hospital and postdischarge opioid requirements in the optimized cohort. For anatomic resections: mean, 60.0 MME (range, 0-60.0 MME) versus mean, 105.0 MME (range, 60.0-150.0 MME), and other procedures: mean, 0 MME (range, 0-60 MME) versus mean, 140.0 (range, 60.0-150.0 MME) ( Conclusions: Small modifications to our protocol for pain management strategies are safe and associated with significant decrease of opioid requirements, particularly schedule II narcotics, during the postoperative period without influencing acute pain levels.
Language	English
Publishing date	2022-01-25
Publishing country	Netherlands
Document type	Journal Article
ISSN	2666-2736
ISSN (online)	2666-2736
DOI	10.1016/j.xjon.2021.09.051
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Article ; Online: Liposomal Bupivacaine Versus Bupivacaine/Epinephrine Intercostal Nerve Block as Part of an Enhanced Recovery After Thoracic Surgery (ERATS) Care Pathway for Robotic Thoracic Surgery.

Kodia, Karishma / Razi, Syed S / Stephens-McDonnough, Joy A / Szewczyk, Joanne / Villamizar, Nestor R / Nguyen, Dao M

Journal of cardiothoracic and vascular anesthesia

2021 Volume 35, Issue 8, Page(s) 2283–2293

Abstract: Objectives: To examine how postoperative pain control after robotic thoracoscopic surgery varies with liposomal bupivacaine (LipoB) versus 0.5% bupivacaine/1:200,000 epinephrine (Bupi/Epi) intercostal nerve blocks within the context of an enhanced ... ...

Abstract	Objectives: To examine how postoperative pain control after robotic thoracoscopic surgery varies with liposomal bupivacaine (LipoB) versus 0.5% bupivacaine/1:200,000 epinephrine (Bupi/Epi) intercostal nerve blocks within the context of an enhanced recovery after thoracic surgery (ERATS) protocol. Design: A retrospective analysis of a prospectively maintained database of patients undergoing robotic thoracoscopic procedures between September 1, 2018 and October 31, 2019 was conducted. Setting: University of Miami, single-institutional. Participants: Patients. Interventions: Two hundred fifty-two patients had either LipoB intercostal nerve blocks (n = 129) or Bupi/Epi intercostal nerve blocks (n = 123) when undergoing robotic thoracic surgery. Measurements and main results: Comparative analysis of patient-reported pain levels, in-hospital and post-discharge opioid requirements, 90-day operative complications, length of hospital stay, and hospital costs was performed. Data were stratified to either anatomic lung resection or pulmonary wedge resection/mediastinal-pleural procedures. Bupi/Epi patients reported significantly more acute postoperative pain than LipoB patients, which correlated with higher in-hospital and post-discharge opioid requirements. There were no differences in postoperative complications, length of hospital stay, or hospital costs between the two groups. Conclusions: As part of an ERATS protocol, infiltration of intercostal spaces and surgical wounds with LipoB for robotic thoracoscopic procedures afforded better postoperative subjective pain control and decreased opioid requirements without an increase in hospital costs as compared with use of Bupi/Epi.
MeSH term(s)	Aftercare ; Anesthetics, Local ; Bupivacaine ; Epinephrine ; Humans ; Intercostal Nerves ; Pain, Postoperative/diagnosis ; Pain, Postoperative/prevention & control ; Patient Discharge ; Retrospective Studies ; Robotic Surgical Procedures/adverse effects ; Thoracic Surgery
Chemical Substances	Anesthetics, Local ; Bupivacaine (Y8335394RO) ; Epinephrine (YKH834O4BH)
Language	English
Publishing date	2021-03-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	1067317-9
ISSN	1532-8422 ; 1053-0770
ISSN (online)	1532-8422
ISSN	1053-0770
DOI	10.1053/j.jvca.2021.02.065
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Zs.A 2203: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Role of Sentinel Lymph Node Biopsy in Microinvasive Breast Cancer.

Fan, Betty / Pardo, Jaime A / Serres, Stephanie / Alapati, Amulya C / Szewczyk, Joanne / Mele, Alessandra / James, Ted A

Annals of surgical oncology

2020 Volume 27, Issue 11, Page(s) 4468–4473

Abstract: Background: Microinvasive ductal carcinoma (DCISM), defined as DCIS with a focus of invasive carcinoma ≤ 1 mm, can be managed similarly to pure DCIS; however, management of the axilla in DCISM has been a subject of debate. Reports in the literature ... ...

Abstract	Background: Microinvasive ductal carcinoma (DCISM), defined as DCIS with a focus of invasive carcinoma ≤ 1 mm, can be managed similarly to pure DCIS; however, management of the axilla in DCISM has been a subject of debate. Reports in the literature differ on the utility and necessity of sentinel lymph node biopsy (SLNB) for DCISM. The aim of the present study was to identify risk factors for nodal disease in patients with DCISM, which can help develop a selective approach to SLNB in this patient population. Methods: The National Cancer Database was used to select patients with DCISM (pT1mi), diagnosed from 2012 to 2015, who underwent SLNB. Multivariable regression analysis was performed to determine associations between sentinel lymph node metastasis and relevant clinical variables. Results: Our cohort comprised of 2609 patients with pT1mi who underwent SLNB. Of these, 76 (2.9%) were found to have sentinel lymph node metastases on final pathology. Low/intermediate grade tumors were associated with decreased SLN metastasis (OR 0.50, CI 0.28-0.92). Age and receptor status of the tumor did not have a clear association in predicting SLN metastases. Conclusions: The rate of sentinel node metastases in DCISM is low at only 2.9% in this national study. Tumor grade was identified as influencing the risk of SLN metastases. This information can factor into shared decision-making for SLNB in patients with DCISM.
MeSH term(s)	Axilla/pathology ; Breast Neoplasms/pathology ; Carcinoma, Intraductal, Noninfiltrating/pathology ; Female ; Humans ; Lymph Nodes/pathology ; Lymphatic Metastasis ; Neoplasm Grading ; Neoplasm Invasiveness ; Sentinel Lymph Node/pathology ; Sentinel Lymph Node Biopsy
Language	English
Publishing date	2020-05-19
Publishing country	United States
Document type	Journal Article
ZDB-ID	1200469-8
ISSN	1534-4681 ; 1068-9265
ISSN (online)	1534-4681
ISSN	1068-9265
DOI	10.1245/s10434-020-08606-3
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Zs.A 4042: Show issues

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Article ; Online: Preoperative anemia: a common finding that predicts worse outcomes in patients undergoing primary hiatal hernia repair.

Chevrollier, Guillaume S / Brown, Andrew M / Keith, Scott W / Szewczyk, Joanne / Pucci, Michael J / Chojnacki, Karen A / Rosato, Ernest L / Palazzo, Francesco

Surgical endoscopy

2018 Volume 33, Issue 2, Page(s) 535–542

Abstract: Background: The increased incidence of anemia in patients with hiatal hernias (HH) and resolution of anemia after HH repair (HHR) have been clearly demonstrated. However, the implications of preoperative anemia on postoperative outcomes have not been ... ...

Abstract	Background: The increased incidence of anemia in patients with hiatal hernias (HH) and resolution of anemia after HH repair (HHR) have been clearly demonstrated. However, the implications of preoperative anemia on postoperative outcomes have not been well described. In this study, we aimed to identify the incidence of preoperative anemia in patients undergoing primary HHR at our institution and sought to determine whether preoperative anemia had an impact on postoperative outcomes. Methods: Using our IRB-approved institutional HH database, we retrospectively identified patients undergoing primary HHR between January 2011 and April 2017 at our institution. We identified patients with anemia, defined as serum hemoglobin levels less than 13 mg/dL in men and 12 mg/dL in women, measured within two weeks prior to surgery, and compared this group to a cohort of patients with normal preoperative hemoglobin. Perioperative outcomes analyzed included estimated blood loss (EBL), operative time, perioperative blood transfusions, failed postoperative extubation, intensive care unit (ICU) admission, postoperative complications, length of stay (LOS), and 30-day readmission. Outcomes were compared by univariable and multivariable analyses, with significance set at p < 0.05. Results: We identified 263 patients undergoing HHR. The median age was 66 years and most patients were female (78%, n = 206). Seventy patients (27%) were anemic. In unadjusted analyses, anemia was significantly associated with failed postoperative extubation (7 vs. 2%, p = 0.03), ICU admission (13 vs. 5%, p = 0.03), postoperative blood transfusions (9 vs. 0%, p < 0.01), and postoperative complications (41 vs. 18%, p < 0.01). On adjusted multivariable analysis, anemia was associated with 2.6-fold greater odds of postoperative complications (OR 2.57; 95% CI 1.36-4.86; p < 0.01). Conclusions: In this study, anemia had a prevalence of 27% in patients undergoing primary HHR. Anemic patients had 2.6-fold greater odds of developing postoperative complications. Anemia is common in patients undergoing primary HHR and warrants consideration for treatment prior to elective repair.
MeSH term(s)	Aged ; Anemia/epidemiology ; Anemia/etiology ; Female ; Hemoglobins/analysis ; Hernia, Hiatal/complications ; Hernia, Hiatal/surgery ; Herniorrhaphy/adverse effects ; Humans ; Incidence ; Length of Stay ; Male ; Middle Aged ; Operative Time ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Preoperative Period ; Prevalence ; Retrospective Studies ; Risk Factors
Chemical Substances	Hemoglobins
Language	English
Publishing date	2018-07-11
Publishing country	Germany
Document type	Journal Article
ZDB-ID	639039-0
ISSN	1432-2218 ; 0930-2794
ISSN (online)	1432-2218
ISSN	0930-2794
DOI	10.1007/s00464-018-6328-4
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