DOCSLIB.ORG

Cervical Mediastinoscopy with Biopsy

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Cervical Mediastinoscopy with Biopsy INFORMED CONSENT INFORMATION ADDRESSOGRAPH DATA CERVICAL MEDIASTINOSCOPY WITH BIOPSY You have decided to have an important procedure and we appreciate your selection of UCLA Healthcare to meet your needs. It is important to you and to us that you fully understand the risks, benefits and alternatives to the procedure you have planned. The purpose of this document is to provide written information regarding the risks, benefits and alternatives to this procedure. The information provided here is a supplement to the discussions you have had with your surgeon(s) in preparation for the procedure. You should read this material and ask your surgeon(s) any questions you have before giving your consent. The Procedure: You have a condition that requires visualization (mediastinoscopy) and possible sampling (biopsy) of the lymph nodes in the center portion of your chest (mediastinum). This is performed in the evaluation of cancers, infections, and other respiratory diseases. During the procedure, a rigid tube with a light and video camera (mediastinoscope) is inserted through a small 1 inch incision just above your breastbone and passed along the outside of your airway. Your surgeon(s) will obtain one or more biopsies, which is done with a miniature device specifically made to take a small sample from the desired lymph node(s). In some cases, your surgeon(s) may also pass the mediastinoscope between some of the large blood vessels to get to specific lymph nodes generally not available during a normal examination (extended mediastinoscopy). This is particularly useful in diseases involving the left lung. The procedure can last from 15 minutes to as long as 1-2 hours, depending on the individual patient’s circumstances. The procedure requires general anesthesia and is frequently performed as an outpatient procedure. Benefits Some benefits that may be gained from diseases involving your lungs and/or undergoing mediastinoscopy are listed chest which might not be detected by below. Your physician cannot guarantee any other test(s) and/or x-ray(s). you will receive any of these benefits. 2. Mediastinoscopy with biopsies may Only you can decide if the benefits are establish a diagnosis, which could worth the associated risk(s). substantially change your future treatment and prognosis. 1. Mediastinoscopy with biopsies may 3. Mediastinoscopy with biopsy, in yield important information about unusual cases, may improve airflow established and/or new (unsuspected) into and out of the lungs by removing 6/5/03 1 large fluid collections or masses that in better breathing following the compress the airway, thereby resulting procedure. Risks Before undergoing this procedure, a blood transfusion. If you require thorough understanding of the associated blood transfusion and have not risks is essential. The following risks are arranged to have your own blood well recognized, but there may be other stored ahead of time and available for risks not included in this list that are the procedure, the use of blood from unforeseen by your surgeon(s): designated or anonymous donors 1. Bleeding in the chest may occur could be necessary. If you receive this during or following the procedure. The type of blood, you could develop chance of bleeding increases if fevers (1 in 100), an allergic reaction multiple biopsies are performed. (1 in 100), red blood cell destruction or Although any bleeding that may occur “hemolytic reaction” (1 in 6000), usually amounts to only a few ounces hepatitis B (1 in 50,000), hepatitis C (1 (30-90 cc) of blood; in rare in 100,000), human immunodeficiency circumstances, bleeding can become viral infection or “HIV” (1 in 500,000), significant and life-threatening, other blood-borne infection, ie., requiring your surgeon(s) to make a syphilis, malaria, Chagas’ disease, large incision through your breastbone other viruses, etc. (1 in 1000), or a (median sternotomy) to stop the severe/fatal acute or allergic reaction bleeding. Occasionally, a small (1 in 100,000). amount of bleeding after the 3. Infections may develop following procedure along with swelling causes mediastinoscopy. Possible infections a lump to form under the incision. This include an infection in the incision, an slowly disappears a few days or up to infection of the major airways a few weeks following the procedure. (bronchitis) and an infection of the Bleeding is made worse by taking lung itself (pneumonia). Infections at aspirin, certain anti-inflammatory insertion sites of intravenous catheters medications (NSAID’s, ie, Advil, Aleve, (i.v.’s) also occur. These infections Vioxx, etc.), and blood thinners (ie, usually are accompanied by fevers coumadin, heparin, etc.). Generally, and either a cough productive of these medications should be stopped yellowish or green phlegm or pain, for a week prior to the procedure. If redness, and possibly drainage at the you are taking any of these incision or at the site of a intravenous medications, please inform your catheter. The treatment of these physician. infections is antibiotics with or without 2. If you have a bleeding problem, have expectorants. With treatment been on blood thinners essentially all infections can be cured. (anticoagulants), or have an anemia 4. Hoarseness may occur following the (low red blood cell count), it may be procedure and is normally due to necessary in rare cases to give you a irritation from the breathing tube used 6/5/03 2 for anesthesia. This lasts only a few abnormal heart beats. Most days. Very infrequently, the nerves arrhythmias that occur are easily going to your vocal cords, which run treated, are temporary (lasting only along side the airway can get minutes to hours), and are not stretched and damaged leading to necessarily an indication of a serious more significant hoarseness. Again, in underlying heart problem. In rare most instances, this is only temporary, circumstances, arrhythmias can lead lasting up to several weeks. Only to low blood pressure requiring the rarely is nerve damage permanent. If brief application of an amount of this occurs, your hoarseness can electrical energy to the heart almost always be improved with vocal (cardioversion) to stop it. If you have cord injections or implants, which severe heart disease, a heart attack or involves a procedure performed by stroke also could occur during or head and neck surgeons. immediately following the procedure, 5. Breathing difficulty with or without a although this is rare. low blood oxygen level may develop 7. Leakage of air from the lung or from during or following mediastinoscopy. the mediastinoscope into the sack This does not occur very frequently surrounding the lung with collapse of but is more likely if you have a pre- the lung (pneumothorax) occurs rarely existing breathing problem, ie., during or shortly following the asthma, emphysema, ªCOPDº, etc. procedure. This usually occurs You could experience wheezing following a biopsy. Many people have and/or chest tightness. During the no symptoms and the pneumothorax procedure you will be given additional is detected only by an x-ray, but some oxygen to breathe, and in simple patients develop mild to severe cases, medications to help your shortness of breath, particularly if breathing may be administered. If you there is a pre-existing lung problem. A develop serious breathing difficulty, small pneumothorax can be observed however, it may become necessary to and may need no treatment, but larger place a breathing (endotracheal) tube pneumothoraces and those associated into your airway to assist your with shortness of breath require a breathing. This could require hospital small tube to be placed through the admission and the use of a skin into the chest to remove the air. mechanical ventilator. This sometimes requires a hospital 6. Abnormal heart beats (arrhythmias) admission. can occur during almost any 8. Medication reactions occur only procedure done on the chest but are rarely during or following rare during mediastinoscopy. You are mediastinoscopy. The medications more likely to develop arrhythmias if commonly used are widely available you have had one previously or have and include lidocaine (similar to dental significant heart problems. If they do novocain), demerol or other morphine- occur, you may experience like drugs, midazolam or Versed palpitations and could require (similar to Valium), and medication to stop or control the metaproterenol or similar agent to 6/5/03 3 dilate bronchial airways. If you have cough and even hoarseness for one or an allergy to any one of these or more days. This is normal and usually similar types of medications, please is easily controlled by over-the-counter inform your surgeon(s) prior to the analgesics, such as acetaminophen procedure. If a reaction occurs, you (Tylenol). Sometimes a stronger could develop a rash, swelling, nausea medication may be necessary and a and/or vomiting, an unusual feeling, prescription for one will be provided for and even wheezing and/or shortness you by your surgeon(s). If you have of breath. A reaction is treated by had a biopsy, you should not use stopping any and all offending aspirin, anti-inflammatory medications medications, and, if necessary, by (NSAID's, ie, Advil, Aleve, Vioxx, etc.), giving you other medications to control or blood thinners (ie, coumadin, your symptom(s). heparin, etc.) unless specifically 9. Discomfort may occur following the approved by your surgeon(s). procedure. General anesthesia is used 10. Death. Life-threatening to eliminate any discomfort during the complications leading to death procedure; however following the following mediastinoscopy are very procedure, you may experience slight rare (<0.1%). throat discomfort with or without a dry Alternatives The alternatives to mediastinoscopy certainly far less accurate than those include the following limited options: obtained with mediastinoscopy. 1. Radiologic evaluation of the lymph 3. Close medical observation can be nodes can be accomplished with used to assess airway problems and computed tomography (CT or ªCATº), their developments over time without magnetic resonance (ªMRº), and invasive procedures, however, the positron emission tomography (PET) main risk of this approach is scans.
Load more

Recommended publications
  • Mediastinoscopic Esophagectomy with Lymph Node Dissection Using a Bilateral Transcervical and Transhiatal Pneumomediastinal Approach
    Tokairin et al. Mini-invasive Surg 2020;4:32 Mini-invasive Surgery DOI: 10.20517/2574-1225.2020.23 Technical Note Open Access Mediastinoscopic esophagectomy with lymph node dissection using a bilateral transcervical and transhiatal pneumomediastinal approach Yutaka Tokairin1,2, Yasuaki Nakajima2, Kenro Kawad2, Akihiro Hoshin2, Takuya Okada2, Toshihiro Matsui2, Kazuya Yamaguchi2, Kagami Nagai2, Yusuke Kinugasa2 1Department of Surgery, Toshima Hospital Tokyo Metropolitan Health and Hospitals Corporation, Tokyo 173-0015, Japan. 2Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo 113-8510, Japan. Correspondence to: Dr. Yutaka Tokairin, Department of Surgery, Toshima Hospital Tokyo Metropolitan Health and Hospitals Corporation, 33-1 Sakaecho, Itabashi-ku, Tokyo 173-0015, Japan. E-mail: [email protected] How to cite this article: Tokairin Y, Nakajima Y, Kawad K, Hoshin A, Okada T, Matsui T, Yamaguchi K, Nagai K, Kinugasa Y. Mediastinoscopic esophagectomy with lymph node dissection using a bilateral transcervical and transhiatal pneumomediastinal approach. Mini-invasive Surg 2020;4:32. http://dx.doi.org/10.20517/2574-1225.2020.23 Received: 17 Feb 2020 First Decision: 17 Mar 2020 Revised: 24 Mar 2020 Accepted: 1 Apr 2020 Published: 16 May 2020 Science Editor: Itasu Ninomiya Copy Editor: Jing-Wen Zhang Production Editor: Tian Zhang Abstract We developed a method for mediastinoscopic esophagectomy via a bilateral transcervical and transhiatal approach under pneumomediastinum as a less-invasive radical operation. The right recurrent nerve is first identified using an open approach, and the right cervical paraesophageal lymph nodes and part of the right recurrent nerve lymph nodes are dissected, after which pneumomediastinum is initiated.
    [Show full text]
  • Airway Obstruction After Biopsy by Cervical Mediastinoscopy in a Patient with a Mediastinal Mass -A Case Report
    Korean J Anesthesiol 2012 July 63(1): 65-67 Case Report http://dx.doi.org/10.4097/kjae.2012.63.1.65 Airway obstruction after biopsy by cervical mediastinoscopy in a patient with a mediastinal mass -A case report- Yong-Cheol Lee2, Sang-Jin Park1, and In-seong Kim1 Department of Anesthesiology and Pain Medicine, 1College of Medicine, Yeungnam University, 2School of Medicine, Keimyung University, Daegu, Korea Biopsy, using mediastinoscopy is commonly employed for accurate histologic diagnosis of a mediastinal mass. However, since the mass is not removed during the procedure, it may cause compression of vital structures such as major airways, the heart, the pulmonary artery, and the superior vena cava after surgery. We observed a case of a 66-year-old man with a mediastinal mass that caused severe airway obstruction during recovery from anesthesia following mediastinoscopic biopsy, probably caused by upper airway edema which seemed to originate from compression of the superior vena cava. Therefore, we suggest that unexpected airway obstruction in a patient with a mediastinal mass can be due to superior vena cava compression. (Korean J Anesthesiol 2012; 63: 65-67) Key Words: Airway obstruction, Mediastinoscopy, Superior vena cava. Biopsies, using mediastinoscopy are commonly utilized Case Report to decide on the treatment of mediastinal masses. However, since the mass is not removed during the biopsy, it may cause A 66-year-old man visited the hospital with a one month compression of vital structures after the procedure [1]. The history of chest discomfort and sporadic swelling in the face superior vena cava has an especially low intravascular pressure and arms in the morning.
    [Show full text]
  • NCCN Guidelines for Patients: Non-Small Cell Lung Cancer
    NCCN.org/patients/surveyPlease complete our online survey at NCCN Guidelines for Patients® Version 1.2016 Lung Cancer NON–SMALL CELL LUNG CANCER Presented with support from: Available online at NCCN.org/patients Ü NCCN Guidelines for Patients® Version 1.2016 Lung Cancer NON-SMALL CELL LUNG CANCER Learning that you have cancer can be overwhelming. The goal of this book is to help you get the best cancer treatment. It explains which cancer tests and treatments are recommended by experts of non-small cell lung cancer. The National Comprehensive Cancer Network® (NCCN®) is a not-for-profit alliance of 27 of the world’s leading cancer centers. Experts from NCCN have written treatment guidelines for doctors who treat lung cancer. These treatment guidelines suggest what the best practice is for cancer care. The information in this patient book is based on the guidelines written for doctors. This book focuses on the treatment of non-small cell lung cancer. Key points of the book are summarized in the related NCCN Quick Guide™. NCCN also offers patient resources on lung cancer screening as well as other cancer types. Visit NCCN.org/patients for the full library of patient books, summaries, and other patient and caregiver resources. ® NCCN Guidelines for Patients i Lung Cancer – Non-Small Cell, Version 1.2016 Endorsers and sponsors Endorsed and sponsored in part by LUNG CANCER ALLIANCE LUNG CANCER RESEARCH COUNCIL Lung Cancer Alliance is proud to collaborate with National Comprehensive As an organization that seeks to increase public awareness and Cancer Network to sponsor and endorse these NCCN Guidelines for understanding about lung cancer and support programs for screening and Patients®: Non–Small Cell Lung Cancer.
    [Show full text]
  • Update in Anaesthesia
    Update in Anaesthesia Pulmonary Function Tests and Assessment for Lung Resection David Portch*, Bruce McCormick *Correspondence Email: [email protected] INTRODUCTION Summary respectively. There are 2400 lobectomies and 500 The aim of this article is to describe the tests available This article describes the for the assessment of patients presenting for lung pneumonectomies performed in the UK each year, steps taken to evaluate resection. The individual tests are explained and we with in-hospital mortality 2-4% for lobectomy and patients’ fitness for lung 4 describe how patients may progress through a series of 6-8% for pneumonectomy. resection surgery. Examples tests to identify those amenable to lung resection. Lung resection is most frequently performed to treat are used to demonstrate interpretation of these tests. Pulmonary function testing is a vital part of the non-small cell lung cancer. This major surgery places It is vital to use these tests in assessment process for thoracic surgery. However, large metabolic demands on patients, increasing conjunction with a thorough for other types of surgery there is no evidence postoperative oxygen consumption by up to 50%. history and examination that spirometry is more effective than history and Patients presenting for lung resection are often high in order to achieve an examination in predicting postoperative pulmonary risk due to a combination of their age (median age accurate assessment of each complications in patients with known chronic lung is 70 years)5 and co-morbidities. Since non-surgical patient’s level of function. conditions. Furthermore specific spirometric values mortality approaches 100%, a thorough assessment of Much of this assessment (e.g.
    [Show full text]
  • Diagnostic Direct Laryngoscopy, Bronchoscopy & Esophagoscopy
    Post-Operative Instruction Sheet Diagnostic Direct Laryngoscopy, Bronchoscopy & Esophagoscopy Direct Laryngoscopy: Examination of the voice box or larynx (pronounced “lair-inks”) under general anesthesia. An instrument called a laryngoscope is carefully placed into the mouth and used to visualize the larynx and surrounding structures. Bronchoscopy: Examination of the windpipe below the voice box in the neck and chest under general anesthesia. A long narrow telescope is passed through the larynx and used to carefully inspect the structures of the trachea and bronchi. Esophagoscopy: Examination of the swallowing pipe in the neck and chest under general anesthesia. An instrument called an esophagoscope is passed into the esophagus (just behind the larynx and trachea) and used to visualize the mucus membranes and surrounding structures of the esophagus. Frequently a small biopsy is taken to evaluate for signs of esophageal inflammation (esophagitis). What to Expect: Diagnostic airway endoscopy procedures generally take about 45 minutes to complete. Usually the procedure is well-tolerated and the child is back-to-normal the next day. Mild throat or tongue discomfort may persist for a few days after the procedure and is usually well-controlled with over-the-counter acetaminophen (Tylenol) or ibuprofen (Motrin). Warning Signs: Contact the office immediately at (603) 650-4399 if any of the following develop: • Worsening harsh, high-pitched noisy-breathing (stridor) • Labored breathing with chest retractions or flaring of the nostrils • Bluish discoloration of the lips or fingernails (cyanosis) • Persistent fever above 102°F that does not respond to Tylenol or Motrin • Excessive coughing or respiratory distress during feeding • Coughing or throwing up bright red blood • Excessive drowsiness or unresponsiveness Diet: Resume baseline diet (no special postoperative diet restrictions).
    [Show full text]
  • A Clinical Prediction Rule for Pulmonary Complications After Thoracic Surgery for Primary Lung Cancer
    A Clinical Prediction Rule for Pulmonary Complications After Thoracic Surgery for Primary Lung Cancer David Amar, MD,* Daisy Munoz, MD,* Weiji Shi, MS,† Hao Zhang, MD,* and Howard T. Thaler, PhD† BACKGROUND: There is controversy surrounding the value of the predicted postoperative diffusing capacity of lung for carbon monoxide (DLCOppo) in comparison to the forced expired volume in 1 s for prediction of pulmonary complications (PCs) after thoracic surgery. METHODS: Using a prospective database, we performed an analysis of 956 patients who had resection for lung cancer at a single institution. PC was defined as the occurrence of any of the following: atelectasis, pneumonia, pulmonary embolism, respiratory failure, and need for supplemental oxygen at hospital discharge. RESULTS: PCs occurred in 121 of 956 patients (12.7%). Preoperative chemotherapy (odds ratio 1.64, 95% confidence interval 1.06–2.55, P ϭ 0.02, point score 2) and a lower DLCOppo (odds ratio per each 5% decrement 1.13, 95% confidence interval 1.06–1.19, P Ͻ 0.0001, point score 1 per each 5% decrement of DLCOppo less than 100%) were independent risk factors for PCs. We defined 3 overall risk categories for PCs: low Յ10 points, 39 of 448 patients (9%); intermediate 11–13 points, 37 of 256 patients (14%); and high Ն14 points, 42 of 159 patients (26%). The median (range) length of hospital stay was significantly greater for patients who developed PCs than for those who did not: 12 (3–113) days vs 6 (2–39) days, P Ͻ 0.0001, respectively. Similarly, 30-day mortality was significantly more frequent for patients who developed PCs than for those who did not: 16 of 121 (13.2%) vs 6 of 835 (0.7%), P Ͻ 0.0001.
    [Show full text]
  • Alternative – Universal Extended Video Mediastinoscopy with Distending, Narrow Blades Extended Video Mediastinoscopy with Distending, Tapered Blade System
    THOR 19 2.0 11/2020-E Alternative – Universal Extended video mediastinoscopy with distending, narrow blades Extended video mediastinoscopy with distending, tapered blade system By creating visibility and space, video mediastinoscopy allows the precise display and dissection of mediastinal structures and is therefore valuable for lymph node staging. Mediastinal staging as well as extended or complex endoscopic interventions, including video-assisted mediastinoscopic lymphadenectomy (VAMLA), can be performed with the aid of a distending video mediastinoscope system. KARL STORZ offers an atraumatic, easy-to-use, compact blade system with a holding arm device and an integrated irrigation and suction channel for this purpose. Two adjustment wheels in the handle allow distal distension of the blades and height adjustment in parallel. Combined with a matching HOPKINS® wide angle telescope, this autoclavable blade system provides the operating surgeon with an optimal overview of the working area. In conjunction with a holding arm with KSLOCK, bimanual work is also possible. The corresponding DCI® camera head IMAGE1 S™ D1 is operated via the modular KARL STORZ IMAGE1 S™ camera platform. Consequently, the system is likely to experience a renaissance in the coming years. We also offer instruments and other accessories that are compatible with the system. © KARL STORZ 96082019 THOR 19 2.0 11/2020 EW-E 2 Components of the KARL STORZ video mediastinoscopy system for extended mediastinoscopy Monitor 27" FULL HD Monitor TM220 Camera System IMAGE1 S CONNECT®
    [Show full text]
  • Consider a Minor Surgery As a Major Surgery and Order Preoperative Tests Accordingly (I.E
    ROUTINE PREOPERATIVE LAB TEST GUIDELINES For adult patients (≥ 16 years) undergoing elective surgery TESTS WITHIN 6 MONTHS OF SURGERY CLINICAL JUDGEMENT IS REQUIRED EXCLUSIONS are valid, provided there has been no interim change as additional tests may be appropriate for patients with this guideline does not apply to patients in the patient’s condition. complex or uncommon surgical or medical conditions. undergoing cardiac surgery or cesarean section. MINOR SURGERY MAJOR SURGERY Associated with an expected blood loss of Associated with an expected blood loss of >500mL, significant fluid shifts and typically, at least one night in <500mL, minimal fluid shifts and is typically hospital*. Includes laparoscopic surgery (except cholecystectomy and tubal ligation); open resection of organs; done on an ambulatory basis (day surgery/ large joint replacements; mastectomy with reconstruction; and spine, thoracic, vascular, or intracranial surgery. same day discharge)*. It includes cataract * If the surgery is typically ambulatory but the patient has a medical or social reason for overnight admission (i.e. OSA, no support surgery; breast surgery without reconstruction; at home), still consider the surgery minor in determining which lab tests to order. laparoscopic cholecystectomy and tubal ligation; and most cutaneous, superficial, All Major Age: 16-49 years old Age: 50+ years old endoscopic and arthroscopic procedures. or Order • add ECG for patients with DM, HTN, Renal, • add ECG + + – DO NOT ORDER PREOP TESTS CBC Cardiovascular or severe Respiratory disease. + + – • add Na , K , Cl , TCO2 including: chest x-rays, Na , K , Cl , TCO , + + – 2 Na K Cl TCO & Cr/ eGFR serum glucose, CBC, ECG, INR, urinalysis, • add , , , 2 for patients with • add Cr/ eGFR renal, liver or thyroid function tests in DM; HTN; Malnutrition; BMI > 40; Renal, Liver or asymptomatic** patients.
    [Show full text]
  • Mediastinoscopy: a Clinical Evaluation of 400 Consecutive Cases
    Thorax: first published as 10.1136/thx.24.5.585 on 1 September 1969. Downloaded from Thorax (1969), 24, 585. Mediastinoscopy: A clinical evaluation of 400 consecutive cases C. L. SARIN1 AND H. C. NOHL-OSER From the Thoracic Surgical Unit, Harefield Hospital, Harefield, Middlesex Mediastinoscopy was carried out in 400 cases, including 296 of bronchogenic carcinoma. At the time of presentation the new growth had already spread to involve the mediastinal lymph nodes in slightly more than 50% of these. The incidence of involvement was 76% in oat-cell and 35% in squamous-cell carcinoma. Non-resectability at thoracotomy was encountered in seven out of 120 patients. We advocate this procedure in every case of bronchogenic carcinoma which is considered operable on other counts. In patients in whom the mediastinal lymph nodes are invaded by growth we prefer radical radiotherapy to surgery, as the long-term survival of the two methods is comparable. This procedure may be the only source of positive histological proof of diagnosis, not only in carcinoma but in other types of intrathoracic disease. We believe that this procedure reduces the number of unnecessary exploratory thoracotomies. Carlens (1959) introduced diagnostic exploration sible. Biopsy in such cases can be obtained from tissues inside the thoracic inlet. in the of the superior mediastinum. The space explored just Bleeding, copyright. is part of the superior mediastinum which is presence of incipient or developed superior vena caval of the obstruction, or dense fibrosis of the pre-tracheal situated around tihe intrathoracic part fascia, can make the procedure difficult or impossible.
    [Show full text]
  • Thoracic Surgery Institution: Nashville VA Medical Center & Duration: 6 Weeks Vanderbilt University Medical Center Supervising Physician: Eric L
    Thoracic Surgery Institution: Nashville VA Medical Center & Duration: 6 weeks Vanderbilt University Medical Center Supervising Physician: Eric L. Grogan, M.D. Contact Information: 615-300-2900 Year of Training: PGY-4 Educational Objectives: During this rotation, the resident will better understand the pathophysiology of thoracic diseases including lung, esophagus, and chest wall diseases. The resident will identify the general risks and complications of thoracic surgery operations, and learn the preoperative and postoperative care of patients undergoing thoracic surgery operations Evaluation of the resident's understanding of the patient and disease process will be reviewed (in part) at the time of operation and through resident-faculty interaction. Feedback will be verbal and timely; residents are encouraged to establish a dialogue with the faculty to facilitate feedback. Residents are expected to notify Dr. Grogan and meet with him when starting the service. Other Comments and Responsibilities Daily rounds will include the General Care Wards and the Intensive Care Unit at the VA. Medical Knowledge and Patient Care: I. CHEST WALL A. Anatomy, Physiology and Embryology Learner Objectives: • Understands the anatomy and physiology of the cutaneous, muscular, and bony components of the chest wall and their anatomic and physiologic relationships to adjacent structures; • Knows various operative approaches to the chest wall. Clinical Skills: • Recognizes the normal and abnormal anatomy of the chest wall. B. Acquired Abnormalities and Neoplasms Learner Objectives: • Evaluates and diagnoses primary and metastatic chest wall tumors, knows their histologic appearance, and understands the indications for incisional versus excisional biopsy; • Knows the radiologic characteristics of tumors. Clinical Skills: • Performs a variety of surgical incisions to expose components of the chest wall and interior thoracic organs.
    [Show full text]
  • Chapter I GENERAL CORRECT CODING POLICIES for NATIONAL CORRECT CODING INITIATIVE POLICY MANUAL for MEDICARE SERVICES
    CHAP1-gencorrectcodingpolicies Revision Date: 1/1/2021 Chapter I GENERAL CORRECT CODING POLICIES FOR NATIONAL CORRECT CODING INITIATIVE POLICY MANUAL FOR MEDICARE SERVICES Current Procedural Terminology (CPT) codes, descriptions and other data only are copyright 2020 American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association. Applicable FARS\DFARS Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors, prospective payment systems, and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for the data contained or not contained herein. Revision Date (Medicare): 1/1/2021 Table of Contents LIST OF ACRONYMS ............................................ I-2 Chapter I ................................................... I-4 General Correct Coding Policies ............................ I-4 A. Introduction ..........................................I-4 B. Coding Based on Standards of Medical/Surgical Practice I-8 C. Medical/Surgical Package .............................I-11 D. Evaluation & Management (E&M) Services ...............I-16 E. Modifiers and Modifier Indicators ....................I-18 F. Standard Preparation/Monitoring Services for Anesthesia .................................................. I-26 G. Anesthesia Service Included in the Surgical Procedure I-26 H. HCPCS/CPT
    [Show full text]
  • Airway Versus Transbronchial Biopsy and BAL in Lung Transplant Recipients: Different but Complementary
    Eur Respir J 1997; 10: 2876–2880 Copyright ERS Journals Ltd 1997 DOI: 10.1183/09031936.97.10122876 European Respiratory Journal Printed in UK - all rights reserved ISSN 0903 - 1936 Airway versus transbronchial biopsy and BAL in lung transplant recipients: different but complementary C. Ward, G.I. Snell, B. Orsida, L. Zheng, T.J. Williams, E.H. Walters Airway versus transbronchial biopsy and BAL in lung transplant recipients: different Dept of Respiratory Medicine, Alfred but complementary. C. Ward, G.I. Snell, B. Orsida, L. Zheng, T.J. Williams, E.H. Walters. Hospital and Monash University Medical ©ERS Journals Ltd 1997. School, Melbourne, Australia. ABSTRACT: Lung transplantation is now an established therapeutic intervention Correspondence: E.H Walters for end-stage cardiopulmonary disease in humans. Chronic rejection, in the form Dept of Respiratory Medicine of bronchiolitis obliterans syndrome (BOS), remains the commonest cause of mor- Alfred Hospital bidity and mortality in those surviving more than 3 months. The pathology of BOS Prahran involves airway changes. We have evaluated the potential for endobronchial biop- Melbourne sies (EBB) to complement existing sampling methods used in allograft monitoring Victoria 3181 and have compared the results of EBB findings with those of bronchoalveolar Australia lavage (BAL) and transbronchial biopsy (TBB) in 18 clinically stable patients. Keywords: Bronchoalveolar lavage We found that all the EBB had inflammatory cells present but that only five endobronchial biopsy TBB specimens had evidence of inflammation, with airway material being present lung transplant in 78% of the TBB. Paired BAL and EBB yielded different results, with no cor- transbronchial biopsy relations between total macrophages, lymphocytes, CD4+ cells or CD8+ cells.
    [Show full text]