Bolivia – Thoracic Surgery

Conference coverage: Bolivian Society of Cardiac, Thoracic and Vascular Surgery

Notes from the day’s lectures at the XVI Congreso Boliviana de Cirugia Cardiaca, Toracica u Vascular in Santa Cruz de la Sierra, Bolivia

This afternoon’s thoracic surgery offerings were provided in a more relaxed, round-table style discussion.

Dr. Edwin Crespo Mendoza, thoracic surgeon, of Santa Cruz, Bolivia led the discussion on diaphragmatic hernia repair and reminded the audience that over 50% of traumatic diaphragmatic hernias go undiagnosed at the time of initial presentation after trauma. To illustrate this, Dr. Crespo presented several cases including a case of post-traumatic hernia diagnosed 13 years after initial auto accident.

Dr. Fernando E. Jemio Ojara, MD (cardiothoracic surgeon) here in Santa Cruz at the Clinica Folanini presented a fascinating case of bilateral lung injury after blunt trauma. In this case, the patient was preparing to undergo urgent repair of a right-sided bronchial tear but during attempted intubation saturations dropped dramatically to 60%. At that time, the patient was placed on ECMO by venous cannulation to maintain oxygenation during the case. The surgeons proceeded with a right posteriolateral thoracotomy. Patient had a short successful ECMO run of 85 minutes, with extubated within 36 hours of surgery, and had no further problems post-operatively,

Dr. Ojara also discussed the mechanism of these type of acceleration – deceleration injuries that most commonly affect the right middle lobe, and how stabilization with ECMO is an effective strategy to repair what is essentially a functional pneumonectomy (in this particularly patient).

Dr. Fidel Silva Julio, Thoracic Surgeon also talked on a similar theme in his overview of closed chest trauma. He reminded the audience that 75-85% of all closed chest trauma patients need some sort of surgical management from chest tube placement to urgent surgery. He reviewed the classic presentations and radiographic findings in some of the most common conditions after chest trauma such as tension pnuemothorax/ sucking chest wounds, flail chest, pneumomediastinum, cardiac tamponade and pulmonary contusions. There were several medical students in the audience, taking notes – so I have included links to the radiology signs mentioned in his lecture, as well as a basic radiology primer.

He also highlighted the need to prevent the typical trauma pitfall of massive volume resuscitation which can prove extremely detrimental in these patients.

More Radiology References

Pericardial effusion

Hamman sign – pneumomediastinum

Scan2 — with surgeons from La Paz, Bolivia

Protected: Register to participate in high altitude research project

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Sociedad Boliviana de Cirugia Cardiaca, Toracica y Vascular

the XXIX Congreso Latinoamericano de cirugia vascular y angiologia in Santa Cruz, Bolivia this October.

The Sociedad Boliviana de Cirugia Cardiaca, Toracica y Vascular has an upcoming conference this October, the XXIX Congreso Latinoamericano de cirugia vascular y angiologia (ALCVA). While much of the conference focuses on cardiovascular topics, there is one day reserved for thoracic surgery topics.

I am attending in hopes of recruiting some of La Paz’s thoracic surgeons into our high altitude project, and will be giving a presentation entitled, “Las verdades esenciales y falsedades sobre el manejo del paciente diabético” on October 6, 2012.

As part of this, I will be bringing readers coverage of this event. If you are going to be Santa Cruz, and you want to talk thoracics -contact me.

Data Collection and Altitude

Developing electronic applications to ease the task of data collection for clinical research.

In clinical research; results are dependent on data. Data is only as good as the data collection tools used to gather it. Furthermore, the best and most accurate data comes from the surgeon or the surgical team themselves at the time of care (versus third-party lay person data collection via chart review). However, there are some limitations that are imposed when following these guidelines; such as the collection of 30-day follow-up information.

Data collection needs to be simple and relatively speedy. The ideal tools allow surgeons to collect the essential data at the time of discharge (when information is fresh), limit additional paper accumulation and are submitted at the time of completion. This necessitates the development of electronic applications.

At the time of this writing, I am currently working on the development of both smart phone and web-based applications for data collection for the altitude project. These electronic forms will allow data to be entered and submitted at the time of collection.

datacollect2screen — smart phones for data collection

A secondary application is being developed to address the patient re-admission or development of complications post-discharge in the first thirty days after discharge.

Downloadable pdfs and/or spreadsheets will also be available for surgeons who elect to use the ‘paper’ option.

Since the data has only limited patient identifiers, and all data is being submitted to a clinical investigator, (versus outside companies) patient privacy is protected.

When completed, further information will be posted here at Cirugia de Torax.

Surgery at altitude, part I

Calling all thoracic surgeons – particularly those in La Paz, Quito, Bogota and Mexico City.. We have an opportunity for collaborative research.

One of our newest endeavors is a research project on thoracic surgery at moderate altitude. We’ve completed our review of existing literature, and developed our patient parameters and data collection points.

The main base of our operations is Flagstaff, Arizona, which is located at 7000 ft. (2,000 meters) making it the highest altitude cardiothoracic program in the United States. The Flagstaff site has several strengths in that much of our patient population comes from the surrounding areas; which are located at both higher and lower elevations. However, one of the weaknesses in Flagstaff is our small patient population – as a single surgeon site devoted to both cardiac and thoracic surgery – our lung surgery volumes are fairly small.

Right now, I am doing some of the preliminary work with the hospital – meeting with staff to apply for IRB approval, and formalizing the data collection process. I am also interested in recruiting surgeons from other sites to participate in data collection. Dedicated thoracic surgeons with large thoracic surgery practices would be ideal – and all results will be published and presented by surgeon/ and site.

We are particularly interested in recruiting surgeons from the following areas:

1. La Paz, Bolivia

2. Quito, Ecuador

3. Bogotá, Colombia

4. Mexico City, DF – Mexico

These four cities combined house many millions of people living at moderate altitudes, and would help provide for a wider and more expansive collection of data on patients undergoing thoracic surgery. Demographic differences (such as pre-existing thoracic diseases, incidence of heavy cigarette smoking, etc.) of geographic locales will also allow for further points of comparison.

Please contact Cirugia de Torax if you are interested in participating. All participating surgeons and institutions will receive credit (in accordance to level of participation) in any and all subsequent professional and scientific publications.

You can also contact me, K. Eckland, directly at : k.eckland@gmail.com. Please place ‘cirugia de torax’ or ‘altitude project’ in the sibject line.