Thoracic surgery clinics
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New oxygenator technologies widened the application of extracorporeal life support significantly in the last decade. Currently the use is still limited within intensive care units. Compared to ventricular assist devices for heart failure, lung replacement technology is lagging behind, not allowing discharge on device. Challenges to achieve a true artificial lung for long term use are discussed in this article.
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Since the advent of lung transplantation more than 5 decades ago, preoperative, surgical, and anesthetic management have improved. The growing experience with extracorporeal membrane oxygenation (ECMO) has enabled clinicians to expand its effective use to care for patients while bridging them to transplant (BTT). ⋯ In patients who continued to meet transplant criteria and were successfully transplanted, postoperative survival rates are acceptable. Larger studies are needed to inform decision algorithms for BTT patients and optimize outcomes.
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Thoracic surgery clinics · Jan 2015
ReviewPleural space complications associated with lung transplantation.
Lung transplantation represents a life-saving option for some end-stage lung diseases. Despite the magnitude of anatomic manipulation and the fragility of the patient population, the procedures have become progressively safer. ⋯ Pleural space complications are particularly common. This article discusses hemothorax, chylothorax, air leak or pneumothorax, recurrent effusion, empyema, trapped lung, and chronic pleural complications.
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Carinal resections and reconstructions, with or without lung resection, are challenging operations that may be indicated in less than 1% of operable patients with NSCLC or benign lesions involving the carina. These operations are completed in only a few centers worldwide, likely because of their technical complexity and the general opinion about their limited patient benefit. However, good survival results can be expected in pN0 or pN1 patients so that, in experienced hands, these operations are effective options. The risk of postoperative complications can be minimized by several intraoperative and postoperative precautions.
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Thoracic surgery clinics · Aug 2014
ReviewPeptide receptor radionuclide therapy for advanced neuroendocrine tumors.
Peptide receptor radionuclide therapy (PRRT) consists of the systemic administration of a synthetic peptide, labeled with a suitable β-emitting radionuclide, able to irradiate tumors and their metastases via internalization through a specific receptor (usually somatostatin S2), over-expressed on the cell membrane. After almost 2 decades of experience, PRRT, with either (90)Y-octreotide or (177)Lu-octreotate, has established itself to be an efficient and effective therapeutic modality. As a treatment, it is relatively safe up to the known thresholds of absorbed and bio-effective isotope dosages and the renal and hematological toxicity profiles are acceptable if adequate protective measures are undertaken.