Lankenau Medical Center

About: Lankenau Medical Center is a healthcare organization based out in Philadelphia, Pennsylvania, United States. It is known for research contribution in the topics: Atrial fibrillation & Medicine. The organization has 436 authors who have published 414 publications receiving 7095 citations. The organization is also known as: Lankenau Hospital.

Institutions Treating Breast Cancer Patients of a Low Socioeconomic Status Achieve Multidisciplinary Quality Standards at Lower Rates.

Abstract: The National Accreditation Program of Breast Centers (NAPBC) certifies institutions that provide quality breast care. Whereas low socioeconomic status (SES) has a negative impact on patient outcomes, it is unknown whether an institution’s patient SES mix is associated with meeting NAPBC standards. All institutions submitting at least 100 breast cancer patients to the National Cancer Database (2006–2017) were ranked based on the patients’ insurance status, income, and education. The 10% treating the largest proportion of low-SES patients were termed low-SES institutions (LSES). Patient cohorts were created based on the 2018 NAPBC standards. Uni- and multivariate comparisons of patient, tumor, and treatment factors were made to calculate adjusted odds of meeting each standard between low- and non-low-SES institutions. The analysis included 1319 institutions. Both the LSES and non-LSES reached the benchmark rate of 50% lumpectomies (61.2 vs 62.9%; p < 0.001), but the unadjusted and adjusted rates of lumpectomy were lower in LSES. The rate for sentinel lymphadenectomy was lower for LSES (49.2 vs 53.7%; p < 0.001). Similarly, the unadjusted and adjusted rates of adjuvant chemotherapy and endocrine therapy were lower at LSES. Although the unadjusted rate of adjuvant radiation was higher at LSES, adjusted odds demonstrated that patients treated at LSES were less likely to undergo adjuvant radiation when appropriate. Small but significant differences in achieving multidisciplinary standards for quality breast cancer care exist between LSES and non-LSES and may exacerbate disparities already faced by patients of low SES.

First reported case of recurrent tachycardia-induced cardiomyopathy due to atrial flutter

Abstract: The patient is a 61-year-old Caucasian male with a history of hypertension and hyperlipidemia who presented in 2010 with 3 days of progressively worsening palpitations, chest tightness and shortness of breath. There was no history of paroxysmal nocturnal dyspnea, orthopnea or syncope. The remainder of the review of symptoms was unremarkable. There is no family history of premature sudden death. His medications were Aspirin, Metoprolol succinate, Lisinopril, Amlodipine and Atorvastatin. He first presented with an arrhythmia in 2007 with a 3-day history of palpitations and light-headedness and he was diagnosed with atrial flutter with 2:1 heart block and a heart rate of 150 beats/min. Transesophageal echocardiography (TEE) revealed normal left ventricular (LV) size with moderately decreased LV systolic function, global hypokinesia and an ejection fraction (EF) of 35% (Fig. 1). There was no left atrial thrombus, hence, he received direct current cardioversion (DCCV) and was converted back to sinus rhythm. His baseline laboratories including thyroid function tests were within normal limits. The follow-up echocardiogram 2 months later revealed normal LV size and systolic function. He was therefore felt to have a resolved Tachycardia-Induced Cardiomyopathy (TIC) at that time and was treated with beta-blockers and aspirin after 1 month of warfarin. Figure 1. EF at presentation of each episode of tachyarrhythmia at 0, 10th and 40th month and subsequent recovery of EF after correction of each episode in 2nd, 14th and 42nd months, respectively. He had another episode of sustained …

Minimally invasive colorectal surgery.

Abstract: Adoption of laparoscopic colorectal surgery has been slow. In the United States, of approximately 250,000 colectomies each year, only 5% to 15% of these cases are being done laparoscopically. Laparoscopic colorectal surgery can be performed successfully on patients for both benign and malignant conditions in any anatomic location of the colon and rectum. The COST trial definitively established that laparoscopic colon surgery for cancer had similar rates of local recurrence and survival compared to open surgery, with better short-term outcomes. It demonstrated that laparoscopic resections resulted in shorter hospital stays, decreased IV narcotics and oral analgesics, and improved quality of life within two weeks of surgery. In the authors' clinical experience of more than 1500 laparoscopic surgeries, patients who undergo laparoscopic colorectal surgery experience decreased rates of wound infection, hernia, and bowel obstruction. One of the challenges of laparoscopic colorectal surgery is standardizing these complex, minimally invasive procedures in the operating room. With standard techniques, one can create optimal outcomes for patients, minimizing perioperative complications and maximizing oncologic results. This paper describes a sequenced step approach for each procedure to facilitate this. Left colectomy follows a nine-step process, and right colectomy follows a four-step process. Both of these procedures are described in detail. The newest horizon in minimally invasive surgery is single incision surgery, which allows for colorectal resections through a single 2.5 cm incision, producing an excellent cosmetic result. Based on this chapter, we advocate the laparoscopic approach be used as the primary method for colorectal surgery.

Transanal Laparoscopic TME with Robot-Assisted Abdominal Laparoscopy

Abstract: Transanal total mesorectal excision (taTME) exists as an excellent new technique for sphincter-preserving surgery in the distal rectum. Convergence of this with a minimally invasive approach from above, albeit laparoscopically or robotically, allows for an extension of sphincter preservation and represents the ultimate application of a minimally invasive approach. In this chapter, we will describe a taTME approach using laparoscopy from below. The abdominal portion of the procedure including release of splenic flexure, high ligation of the inferior mesenteric artery and inferior mesenteric vein (IMV), mobilization of the colon, and completion of the TME dissection from above will be described using a robotic technique. Anatomic and technical approaches will be highlighted demonstrating the evolving field of rectal cancer surgery.