Seminars in thoracic and cardiovascular surgery
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Semin. Thorac. Cardiovasc. Surg. · Jan 2006
ReviewARDS and diffuse alveolar damage: a pathologist's perspective.
Diffuse alveolar damage (DAD) is the histologic correlate of most patients with adult respiratory distress syndrome (ARDS). It is a relatively straight forward diagnosis and the main differential diagnosis clinically is acute pneumonia and histologically is bronchiolitis obliterans and organizing pneumonia (BOOP). The histologic progression of DAD includes 3 phases (exudative, proliferative, and fibrotic) that correlate with the time rather than its specific cause. The factors that govern which patients will do well and which will develop a fulminant course is not known.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2006
ReviewTechnical advances of pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension.
Pulmonary endarterectomy is the definitive treatment for chronic pulmonary hypertension as the result of thromboembolic disease. Although significant progress has been made over the last decade in recognition, diagnostic modalities, and treatment of this disease, chronic thromboembolic pulmonary hypertension (CTEPH) continues to be severely underdiagnosed and as a consequence pulmonary endarterectomy remains an uncommon procedure. ⋯ Medical management in these patients is only palliative, and surgery by means of transplantation for this type of pulmonary hypertension is an inappropriate use of resources with less than satisfactory results. In this article we describe the technical advances of pulmonary endarterectomy and the current procedure as it is performed at University of California-San Diego Medical Center.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2006
ReviewThe dispersed neuroendocrine system, its bronchopulmonary elements, and neuroendocrine tumors presumed to be derived from them: myths, mistaken notions, and misunderstandings.
The increasing recognition of the dispersed neuroendocrine system and its importance in human physiology has impacted our understanding of physiology, pathophysiology, and histopathology. It has been the subject of a great deal of controversy and debate, giving rise to certain misunderstandings. This article attempts to put some of these issues in perspective, especially as they relate to the bronchopulmonary tree.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2006
Minimally invasive approaches to aortic valve surgery: Brigham experience.
Aortic valve surgery is a proven and effective therapy for severe aortic stenosis and insufficiency. Conventional aortic valve surgery is performed with a full sternotomy, cardiopulmonary bypass, and replacement of the diseased aortic valve. Unlike minimally invasive (or "off-pump") coronary artery bypass, minimally invasive aortic valve surgery still requires cardiopulmonary bypass but refers primarily to smaller incisions and access. ⋯ The upper hemisternotomy has become our standard approach to isolated aortic valve surgery. It is a safe and effective technique with a similar morbidity and mortality to conventional aortic valve surgery. Patients derive clear benefits from this minimally invasive approach including less pain, shorter length of hospital stay, and faster return to preoperative function levels.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2006
ReviewIntensive insulin therapy in high-risk cardiac surgery patients: evidence from the Leuven randomized study.
Mortality and morbidity of critically ill diabetic as well as nondiabetic patients are improved when blood glucose levels are tightly controlled to normoglycemia with intensive insulin therapy during their stay in the intensive care unit (ICU). This has been demonstrated in large prospective, randomized, controlled clinical studies for adult patients admitted to surgical and medical ICUs. Particularly for cardiac surgery patients, the hospital survival benefit with insulin therapy is most pronounced and maintained up to 4 years after hospital discharge, without inducing a substantial burden for the patients, their relatives, or society. Mechanistic studies exploring the molecular pathways involved suggest that intensive insulin therapy exerts its beneficial effects mainly through the maintenance of normal blood glucose levels.