Thoracic surgery clinics
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Thoracic surgery clinics · May 2013
ReviewRelevance of endoscopic ultrasonography and endobronchial ultrasonography to thoracic surgeons.
Although cervical mediastinoscopy has been considered the gold standard for mediastinal staging in non-small cell lung cancer, new minimally invasive endoscopic ultrasound technology, such as endobronchial ultrasound-guided transbronchial needle aspiration and endoscopic ultrasound fine-needle aspiration, have changed the practice of invasive staging. Based on the current evidence, minimally invasive endoscopic staging is the recommended choice in patients with high pretest probability of lymph node metastasis; however, all negative results should be verified by mediastinoscopy, especially in centers with low expertise. In patients with low pretest probability, mediastinoscopy may be omitted when adequate sampling is achieved with endoscopic modalities.
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Thoracic surgery clinics · May 2013
ReviewSystematic approach to the management of the newly found nodule on screening computed tomography: role of dedicated pulmonary nodule clinics.
Indeterminate pulmonary nodules in asymptomatic individuals are common, and their incidence is expected to increase. Although evidence-based guidelines exist for the management of these lesions, they are not in complete agreement and are often not followed, resulting in inconsistent management. A dedicated program or clinic for the management of lung nodules would allow an institution to deliver evidence-based, standardized care for patients with indeterminate nodules, and should include multidisciplinary care, state-of-the-art technology and expertise, and a patient navigation system to provide a user-friendly service for both patients and referring physicians. A dedicated pulmonary nodule clinic has many potential advantages.
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Thoracic surgery clinics · Feb 2013
ReviewPermanent indwelling catheters in the management of pleural effusions.
The treatment of chronic recurrent pleural effusions continues to evolve with the recent emergence of tunneled indwelling pleural catheters (IPCs). Talc pleurodesis has been the standard of care for treatment of recurrent pleural effusions, but IPCs have gained more favor in recent years. IPCs offer several advantages, including a less invasive procedure, short postprocedure hospital stay, and greater patient control in the management of symptoms. Further randomized controlled studies are needed to more clearly differentiate which patients are better served by an IPC rather than traditional pleurodesis as their initial intervention.
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Thoracic surgery clinics · Feb 2013
ReviewCauses and management of common benign pleural effusions.
Benign pleural effusions are twice as common as malignant effusions and have diverse causes and manifestations, which often makes them a diagnostic challenge. Differentiating effusions as a transudate or exudate is the first, and often helpful, step in directing investigations for diagnosis and management. ⋯ Commonly exudative effusions are caused by infections or may be secondary to pulmonary embolism, drugs, collagen vascular diseases, or may follow cardiac surgery. This article gives an overview of the causes and management of common benign pleural effusions.
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Thoracic surgery clinics · Feb 2013
ReviewDecision making and algorithm for the management of pleural effusions.
Pleural effusions can be catagorised in to transudative effusions or exudative effusions. Causes include cardiovascular disease, infection and neoplasm. ⋯ Thoracocentesis and laboratory testing of the pleural fluid is usually diagnostic and can direct further investigations or treatment. Management of the pleural effusion ultimately varies according to the diagnosis but can be either directed towards reversing the cause of the effusion or treating the symptoms that arise as a result of the effusion.