Seminars in thoracic and cardiovascular surgery
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Semin. Thorac. Cardiovasc. Surg. · Jan 2009
ReviewCurrent status of screening for malignant pleural mesothelioma.
Malignant mesothelioma is characterized by its association with asbestos, its long latency period, and the propensity for the diagnosis to be obtained in the later stages of the disease. Because the high-risk cohorts for mesothelioma are fairly well defined by the association with asbestos, and the exposure is usually in the workplace, it is hypothesized that early detection of the disease could (1) find patients at an earlier, more treatable stage and (2) result in prolonged survival over the present median 12 months from the start of therapy. ⋯ Most recently, serum biomarkers with the potential to discriminate asbestos-exposed, non-cancer-bearing individuals from those with mesothelioma have been investigated both at single institutions and with multi-institutional-blinded trials. These markers, including soluble mesothelin-related protein, osteopontin, and megakaryocyte potentiating factor, may, in the future, be incorporated into a screening algorithm for high-risk asbestos-exposed individuals to help monitor these cohorts in a noninvasive fashion and guide the use of computerized tomography.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2009
ReviewAnatomical, histologic, and genetic characteristics of congenital chest wall deformities.
There is a large and diverse group of congenital abnormalities of the thorax that manifest as deformities and/or defects of the anterior chest wall and, depending on the severity and concomitant anomalies, may have cardiopulmonary implications. Pectus excavatum, the most common anterior chest deformity, is characterized by sternal depression with corresponding leftward displacement and rotation of the heart. Pectus carinatum, the second most common, exhibits a variety of chest wall protrusions and very diverse clinical manifestations. ⋯ Collagen, as a major structural component of rib cartilage, is implicated by genetic and histologic analysis. Poland syndrome is a unique unilateral chest/hand deficiency that may include rib defects, pectoral muscle deficit, and syndactyly. Cleft sternum is a rare congenital defect resulting from nonfusion of the sternal halves, which leaves the heart unprotected and requires early surgical intervention.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2009
ReviewTeaching off-pump coronary artery bypass surgery.
Off-pump coronary artery revascularization requires a unique skill set and a different conduct of operation compared with on-pump coronary artery bypass. Not only must the surgeon perform anastomoses on the beating heart, but he/she must understand the hemodynamic consequences of cardiac positioning and stabilization, the effects of regional ischemia on hemodynamic function, contractility, and arrhythmias, and the importance of anesthesia and grafting sequence given variants of anatomy and clinical conditions. Given these differences, the ability to teach off-pump coronary artery bypass to residents and surgeons places unique demands on the teaching surgeon. In this article, we review the available literature about the safety and efficacy of teaching off-pump coronary artery bypass to residents, discuss the fundamentals for training residents, and review the future of simulation and new training paradigms and the impact this will have on current training methods.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2009
Bronchoscopic evaluation of the trachea and dilation of the trachea.
Flexible and rigid bronchoscopy are the thoracic surgeon's stethoscope. These tools are vital to evaluating, diagnosing, and treating a tracheobronchial pathologic condition. Airway dilation, used appropriately and selectively, is an effective method of treating various tracheal pathologic conditions.
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Multidetector computed tomography (CT) allows for an accurate, noninvasive means of evaluating tracheal anatomy and pathology. The integration of information obtained from axial images, multiplanar reformats and 3-D rendering enables precise anatomical localization of tracheal pathology, provides detailed information on surrounding structures, aids in surgical planning, and allows for assessment of posttreatment response. Although bronchoscopy remains the gold standard in the diagnosis of tracheal pathology, the proper utilization of radiologic imaging can allow for improved patient care.