Thoracic surgery clinics
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Thoracic surgery clinics · Aug 2012
ReviewMultidrug-resistant pulmonary tuberculosis: surgical challenges.
Multidrug-resistant tuberculosis (MDR-TB) continues to be a significant public health problem worldwide. The treatment of MDR-TB consists mainly of chemotherapy. ⋯ This article discusses the scope of the problem of MDR-TB and the most accepted modern standard therapy. The indications for surgical intervention as well as an analysis of the results of this therapy are also discussed.
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Thoracic surgery clinics · May 2012
ReviewUltrasound-guided transbronchial and transesophageal needle biopsy in the mediastinal staging of lung cancer.
This review presents the current state of two endosonographic techniques, endobronchial ultrasonography (EBUS) and endoscopic ultrasonography (EUS), and their application in the mediastinal staging of patients with lung cancer. The technique for these procedures is presented and their diagnostic yield is discussed, based on the published evidence. EBUS and EUS, especially in combination with needle aspiration biopsy, emerge as the primary modalities for mediastinal staging because of their high diagnostic yield, minimal invasiveness, low cost, and avoidance of disruption of mediastinal lymphatic pathways before the final treatment.
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Thoracic surgery clinics · May 2012
ReviewPET staging of mediastinal lymph nodes in thoracic oncology.
There is an extensive and growing body of literature about the role of positron emission tomography (PET) in the management of non-small cell lung cancer and esophageal cancer. This article focuses on the use of PET in mediastinal staging of these common thoracic malignancies. ⋯ The role of PET in mediastinal lymph node staging in esophageal cancer is less clear, since it has been largely supplanted by endoscopic ultrasonography. A review of the evidence for and against the use of PET in mediastinal staging is provided and the use of PET in practice is discussed.
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No official guidelines exist for perioperative antibiotic use in noncardiac thoracic surgery. Despite some conflicting data and few randomized clinical trials there exists strong evidence supporting the use of perioperative antibiotic prophylaxis in pulmonary resection. This article discusses the evidence-based indications for antibiotic prophylaxis after lung resection, esophageal surgery, and lung transplantation.
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Smoking is the leading cause of preventable death worldwide. Smoking cessation programs that include counseling and pharmacotherapy have been proved to be effective in achieving long-standing abstinence. ⋯ Longer-term quit rates are generally higher in cohorts who quit in anticipation of surgery compared with those quitting for general health considerations. A team approach and adherence to the guidelines for smoking cessation improves long-term chances of success.