Chest surgery clinics of North America
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Because the lung cancer epidemic shows no signs of abating, little doubt exists that the need for interventional bronchoscopists will persist for many years to come. The Nd:YAG laser and the rigid bronchoscope remain crucial weapons in the fight against lung cancer. With more than 4000 published interventions pertaining to it, this combination is ideal for treating central airways obstruction. ⋯ Although it is unclear what role these technologies will have, prospective controlled studies must be done to help clarify this question. The future may lay in combining these various technologies along with Nd:YAG laser bronchoscopy to maximize the therapeutic, palliative, and possibly even curative effect. As the experience of the medical community with Nd:YAG laser bronchoscopy continues to grow and as more health-care professionals are made aware of its therapeutic capability, fewer patients with cancer will need to suffer and die from the complications of airway obstruction.
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The rigid bronchoscope is a unique and invaluable instrument that allows evaluation, control, and therapeutic manipulation of the proximal tracheobronchial tree. Massive hemoptysis, foreign body removal, airway stenosis, laser resection, and pediatric bronchoscopy are the most common indications for the rigid bronchoscope. Improved anesthetic agents have improved the safety and comfort of the procedure for patients having either diagnostic or therapeutic procedures. The ability to use the rigid bronchoscope in therapeutic situations depends, however, on a level of skill and experience with the instrument that can be obtained only by its frequent use for diagnostic indications in the proximal airway.
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Chest Surg. Clin. N. Am. · Nov 2001
ReviewEndoscopic management of airway complications after lung transplantation.
Airway complications remain a source of significant morbidity after lung transplantation. The current incidence of such complications is 12% to 15%. The associated mortality is 2% to 3%. ⋯ Similarly, the routine use of vascularized soft tissue reinforcement no longer seems justified. Most complications can be managed readily with a combination of endoscopic techniques, including débridement (with or without laser or cryotherapy), dilation, and stent placement. Resective procedures rarely are indicated, and retransplantation should be reserved for exceptional cases.
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Chest Surg. Clin. N. Am. · Nov 2000
Review Comparative StudyPrevention of lung cancer. The new millennium.
Lung cancer is the leading cause of cancer-related death worldwide and in the United States surpassing breast, prostate, and colon cancer. Treatment of this disease over the past 2 decades has advanced incrementally as survival rates have improved only slightly. ⋯ Chemoprevention has introduced a new arena of treatment options for early intervention in lung carcinogenesis. The use of molecularly targeted therapeutic and biologic agents constitutes novel strategies for lung cancer prevention in the new millennium.
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The large clinical studies of lung cancer screening carried out more than 20 years ago were interpreted as evidence against screening. Those studies have been recently reassessed in the light of methodologic flaws in the randomization of subjects at risk for lung cancer. There is no evidence to support the former conclusion that screening is ineffective and the consequent official recommendation not to screen for lung cancer. ⋯ Low-dose helical CT scan is currently believed to represent a very useful technique for screening for lung cancer, with a higher sensitivity than chest radiograph screening. Chest radiography for lung cancer screening, however, is cheaper and ubiquitously available, and it should still be recommended if CT scan is locally unavailable. As underscored in a recent commentary in The Lancet, the existing public health policy discouraging the screening for lung cancer is in urgent need of reconsideration.