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Background The standard for clinical staging of lung cancer is the use of CT and PET scans, however, these may underestimate the burden of the disease. The use of serum tumor markers might aid in the detection of subclinical advanced disease. The aim of this study is to review the predictive value of tumor markers in patients with clinical stage I NSCLC. Methods A comprehensive search was performed using the Medline, EMBASE, Scopus data bases. Abstracts included based on the following inclusion criteria: 1) adult ≥18 years old, 2) clinical stage I NSCLC, 3) Tumor markers (CEA, SCC, CYFRA 21-1), 4) further imaging or procedure, 5) > 5 patients, 6) articles in English language. The primary outcome of interest was utility of tumour markers for predicting nodal involvement and oncologic outcomes in patients with clinical stage I NSCLC. Secondary outcomes included sub-type of lung cancer, procedure performed, and follow-up duration. Results Two hundred seventy articles were screened, 86 studies received full-text assessment for eligibility. Of those, 12 studies were included. Total of 4666 patients were involved. All studies had used CEA, while less than 50% used CYFRA 21-1 or SCC. The most common tumor sub-type was adenocarcinoma, and the most frequently performed procedure was lobectomy. Meta-analysis revealed that higher CEA level is associated with higher rates of lymph node involvement and higher mortality. Conclusion There is significant correlation between the CEA level and both nodal involvement and survival. Higher serum CEA is associated with advanced stage, and poor prognosis. Measuring preoperative CEA in patient with early stage NSCLC might help to identify patients with more advanced disease which is not detected by CT scans, and potentially identify candidates for invasive mediastinal lymph node staging, helping to select the most effective therapy for patients with potentially subclinical nodal disease. Further prospective studies are needed to standardize the use of CEA as an adjunct for NSCLC staging.

The diagnosis and management of tracheobronchial papilloma is challenging due to its rarity, and non-specific presenting symptoms. Small percentage undergoes malignant transformation. Herein, we report an unusual case of tracheal papilloma initially misdiagnosed as chronic obstructive pulmonary disease (COPD) in 36-year-old male with triple Y syndrome. It was successfully treated with local debridement and brachytherapy. To the best of our knowledge, this is the first description of brachytherapy for such a condition.

The use of intrapleural fibrinolytics for complicated parapneumonic effusion has been shown to be an effective and safe alternative to surgery. However, there is limited evidence about its use during pregnancy. We present a case and a review of the literature of pregnant women who had successful treatment of their complicated parapneumonic effusion with intrapleural fibrinolytics. To our knowledge this is the first review of cases of pregnant women with parapneumonic effusion managed with intrapleural fibrinolytic.

Objective The use of sentinel lymph node biopsy (SLNB) has been gaining popularity with the emergence of indocyanine green (ICG) fluorescence imaging. We aimed to systematically review the literature and perform a meta-analysis on the diagnostic accuracy of SLNB using ICG for lung cancer. Methods A comprehensive search of MEDLINE, EMBASE, SCOPUS, Web of Science, and the Cochrane Library using search terms “lung/pulmonary” AND “tumor/carcinoma/cancer/neoplasm/adenocarcinoma/malignancy/squamous/carcinoid” AND “indocyanine green” was completed in June 2018. Articles were selected based on the following inclusion criteria: (1) diagnostic accuracy study design; (2) ICG injected at the tumor site with near-infrared fluorescence imaging identification of sentinel lymph nodes; (3) lymphadenectomy or sampling was performed as the gold standard. Results Eight primary studies were included with a total of 366 patients. 43.0% of patients were females and the mean tumor size was 2.3 cm. Sentinel lymph nodes were identified with ICG in 251 patients, yielding a pooled identification rate of 0.83 (0.67–0.94). A meta-analysis of seven studies computed a diagnostic odds ratio, sensitivity, and specificity of 177.6 (45.6–691.1), 0.85 (0.71–0.94), and 1.00 (0.98–1.00), respectively. The summary receiver operator characteristic demonstrated an area under the curve of 0.963 (SE = 0.038) and a Q * of 0.91 (SE = 0.057). Conclusion Our review found suboptimal results for the diagnostic accuracy of SLNB using ICG and must be improved before routine clinical use. Further research is required to develop a robust protocol for the use SLNB with ICG for lung cancer.

Plexiform fibromyxoma of the stomach, also known as plexiform angiomyxoid myofibroblastic tumor, is a rare benign gastric mesenchymal tumor, first described in 2007, which usually arises in the gastric antrum and affects adults. Few cases have been reported in children and adolescents. It can present with different clinical manifestations including abdominal pain, dyspepsia, hematemesis, and vomiting. Preoperatively, this tumor is usually diagnosed as gastrointestinal stromal tumor (GIST), and the correct diagnosis is made only after histopathological examination following surgical resection. Most cases were reported from East Asia (China, Japan, and Korea), North America, and Europe. We report herein a unique case of plexiform fibromyxoma, the first to be reported from the Middle East, arising in the cardia of the stomach in a 16-year-old adolescent male, with a brief review of the literature.

Gastroesophageal intussusception is a rare but clinically significant condition necessitating prompt diagnosis and management. This highlights the importance of early recognition and intervention to prevent severe complications such as oesophageal perforation. Endoscopic assessment and surgical intervention remain the cornerstone of the management, tailored to the clinical severity and surgeon's expertise. The prognosis largely depends on the timeliness of diagnosis and intervention, with early treatment typically resulting in favourable outcomes.

ABSTRACT The use of Prolene mesh for repair of various hernias is very common. As with any surgical procedure, it can be associated with complications such as seroma, hematoma and wound infection. However, it is uncommon to develop heterotopic ossification following incisional hernia repair with Prolene mesh. Herein, we report a case with chronic abdominal pain secondary to heterotopic ossification occurring after incisional hernia repair with Prolene mesh. It is crucial to report uncommon reactions to the mesh in order to aid in diagnosis of unexplained abdominal pain post hernia repair, after common etiologies are ruled out.

Weight loss is the primary outcome following bariatric surgery; however, its documentation within current literature is heterogeneous and poorly defined, limiting meaningful comparison between studies. Randomized controlled trials from 2012 to 2016 were identified using the Medline database through “Gastric bypass OR sleeve gastrectomy AND weight” search terms. A total of 73 studies with 5948 patients were included. Reporting of preoperative weight was done primarily using mean body mass index (BMI) (87.7%) and mean weight (65.8%). Postoperative weight reporting was more variable, with the most frequently reported measure being mean postoperative BMI (71.2%). Overall, nearly one third of all bariatric literature contained discrepancies that precluded meaningful meta-analysis. Reporting of weight loss following bariatric surgery is becoming increasingly diverse for both pre- and post-operative outcomes. Ongoing heterogeneity will continue to act as a barrier to meaningful comparison of bariatric outcomes until standardized reporting practices become adopted.

Background: The Education and Continuing Professional Development Committee (ECPDC) of the Canadian Association of Thoracic Surgeons (CATS) has defined a goal of describing the essential knowledge of thoracic surgery for primary care physicians and other nonsurgeons. The objective of this research was to develop a national standardized set of undergraduate learning objectives for thoracic surgery. Methods: Institutional thoracic surgery learning objectives were obtained from 4 medical schools in Canada. These 4 institutions were selected to provide a broad geographic representation from medical schools of varying sizes and of both official languages. The resulting list of learning objectives underwent critical review by the ECPDC, made up of 5 Canadian community and academic thoracic surgeons, 1 thoracic surgery fellow and 2 general surgery residents. A national survey was developed and circulated by CATS. The survey was sent to all CATS members (n = 209). Respondents were asked to indicate on a 5-point Likert scale whether each objective \"should be a priority for all medical students\" (strongly disagree = 1, strongly agree = 5). Results: Out of the 209 CATS members, 56 responded (response rate 27%). The average experience in clinical practice among survey responders was 10.6 ± 10.0 years. Most survey responders were from Ontario (38.9%). Most survey responders teach or supervise medical students monthly (37.0%), with one-third reporting this daily (29.6%). Eight out of the 10 proposed objectives received a mean Likert score of 4/5 or higher and were selected for inclusion in the final list. Following final review from the ECPDC and CATS Executive Committee, a finalized list of 8 learning objectives was created. Conclusion: A standardized set of learning objectives reflective of the core concepts within thoracic surgery was developed for medical students using a systematic approach.