Seminars in thoracic and cardiovascular surgery
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Semin. Thorac. Cardiovasc. Surg. · Jan 2004
ReviewDonor management and selection for heart transplantation.
The success of cardiac transplantation has led to its widespread application for all etiologies of end-stage heart disease. As a result, this has resulted in a severe shortage of available donor organs. ⋯ This has translated into harvesting of older donor hearts, from more unstable donors as well as from more distant locations. Of utmost importance is that when the decision is made to proceed with cardiac transplantation, the risk/benefit ratio associated with cardiac transplantation in that particular patient must be weighed against the mortality and morbidity risk while remaining on the heart transplant waiting list.
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Better understanding of the mechanisms of ischemia-reperfusion injury, improvement in the technique of lung preservation, and the recent introduction of a new preservation solution specifically developed for the lungs have helped to reduce the incidence of primary graft dysfunction after lung transplantation. Currently, the limitation in extending the ischemic time is more often related to the increasing use of non-ideal lung donors rather than to poor lung preservation. In this review, we have focused our attention on the experimental and clinical work performed to optimize the methods of lung preservation from the time of retrieval to the period of reperfusion after graft implantation.
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As the complexity of congenital heart care increases, and expectations for improved outcomes grow, the limitations of current medical information management systems are exposed. Despite advances in information management technology, achieving a state of information resonance within a congenital heart team, where comprehensive patient data and real time program performance can be intuitively accessed on demand, remains an elusive goal. ⋯ We designed and implemented an Internet based information management system to collect, store and exchange comprehensive patient information, and measure clinical performance in real time. Use of this system has been associated with improved clinical outcomes for a congenital heart team.
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The widespread application of lung transplantation is limited by the shortage of suitable donor organs resulting in longer waiting times for listed patients with a substantial risk of dying before transplantation. To overcome this critical organ shortage, some transplant programs have now begun to explore the use of lungs from circulation-arrested donors, so called non-heart-beating donors (NHBDs). ⋯ Techniques for NHBD lung preservation and pretransplant functional assessment are reviewed. Ethical issues involved in transplanting lungs from asystolic donors are discussed.
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Semin. Thorac. Cardiovasc. Surg. · Oct 2003
ReviewNonsmall-cell lung cancer: chemoprevention studies.
Lung cancer is the leading cause of cancer-related death in the world. Tobacco is an addictive agent producing carcinogenic effects that have been extremely difficult to prevent or detect in a curable stage. Important randomized controlled studies have been published in "healthy" smokers (primary prevention); patients with early lesions, such as mucosal dysplasia/metaplasia (secondary prevention); and those who have already had definitive treatment for their first tobacco-related malignancy (tertiary prevention). ⋯ We now have unprecedented knowledge regarding the control of cellular growth and senescence. New diagnostic tools also allow detection of smaller lesions. We must use all our knowledge of the cancer biology, new risk models, more refined intermediate markers, and modern detection tools to focus more clearly on the pathology of lung cancer and design research to ask more probing and relevant questions so we can begin to put an end to the worldwide scourge of this terrible killer.