Seminars in thoracic and cardiovascular surgery
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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.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2008
ReviewEndobronchial ultrasound-guided transbronchial needle aspiration for mediastinal lymph node staging in non-small cell lung cancer.
Mediastinoscopy is the gold standard for mediastinal lymph node (MLN) staging for non-small cell lung cancer patients; however, mediastinoscopy is invasive and allows access to a limited number of American Thoracic Society MLN stations (1, 2, 3, 4, and 7). Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is emerging as a useful, less invasive staging technique that offers access to a wider range of MLN stations (2, 3, 4, 7, 10, and 11). Although EBUS-TBNA has excellent sensitivity and diagnostic accuracy, an alternative MLN biopsy technique (i.e., mediastinoscopy or thoracoscopy) is required to confirm negative cytology findings, especially after induction therapy. Additionally, an experienced cytopathologist is critical to establishing an effective EBUS-TBNA program.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2008
ReviewHyperthermic chemoperfusion for the treatment of malignant pleural mesothelioma.
Malignant pleural mesothelioma is a uniformly fatal disease with a poor prognosis. Multimodality therapy, including macroscopic complete resection, chemotherapy and/or radiotherapy, has improved survival relative to historical controls, but local recurrence remains problematic. Novel strategies are needed to improve local control. ⋯ Our experience and technique of hyperthermic IC is described. The evolution of our experience has led to the use of pharmacologic renal cytoprotection, which has permitted the safe administration of higher doses of IC than previously described. Further trials are being performed with a multidrug combination following macroscopic complete resection.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2008
ReviewTargeted therapy for the treatment of non-small cell lung cancer: focus on inhibition of epidermal growth factor receptor.
Systemic chemotherapy is the standard treatment for patients with advanced stage non-small cell lung cancer (NSCLC) and improves both their survival and quality of life. Despite this, the overall prognosis for advanced NSCLC remains poor. Molecularly targeted therapies are being developed in an effort to improve outcomes for patients with advanced NSCLC. ⋯ EGFR signal may be blocked with small molecule inhibitors of the tyrosine kinase of EGFR (erlotinib, gefitinib) and with monoclonal antibodies against the ligand-binding domain (cetuximab). Erlotinib and gefitinib are in clinical use as single agents for the treatment of NSCLC and recent data suggest cetuximab improves survival when combined with chemotherapy for the treatment of metastatic NSCLC. This article reviews the role of currently available and emerging EGFR inhibitors in the treatment of NSCLC.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2008
ReviewThe new lung allocation system and its impact on waitlist characteristics and post-transplant outcomes.
Historically, waiting time was the primary determinant of lung organ allocation in the United States. Under this system, waiting time grew progressively longer as the annual number of transplants reached a plateau, and every year, a considerable number of candidates died while waiting. ⋯ Early evaluations of the new system indicate that waiting time has decreased, the total number of transplants has increased, waitlist mortality may be decreasing, and survival after transplantation remains unchanged. Over time, refinements in the lung allocation score will likely reduce waitlist mortality further and maintain or perhaps improve survival after transplantation.