Thoracic surgery clinics
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Thoracic surgery clinics · May 2009
Treatment of heterogeneous emphysema using the spiration IBV valves.
Ninety-eight emphysema patients were treated at 13 international sites during a 3-year series of single-arm, open-label studies with the IBV valve and a multi-lobar treatment approach. Fifty six percent of subjects had a clinically meaningful improvement in health-related quality of life, but standard pulmonary function and exercise studies were insensitive effectiveness measures. ⋯ Lung volume reduction was an uncommon mechanism for a treatment response with bilateral upper lobe treatment. A redirection of inspired air, an interlobar shift to health-ier lung tissue, was the most common mechanism for a valve treatment response.
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Thoracic surgery clinics · May 2009
ReviewUpdate on donor assessment, resuscitation, and acceptance criteria, including novel techniques--non-heart-beating donor lung retrieval and ex vivo donor lung perfusion.
The shortage of adequate organ donors remains a great challenge in clinical lung transplantation. With increasing experience in the medical management and surgical technique of lung transplantation, gradual expansion of the criteria for lung donor selection has occurred with beneficial effects on the donor pool. Interest in donation after cardiac death also is increasing as the gap increases between donors and the needs of listed patients. ⋯ As the predictive ability to discern good from injured donor lungs improves, strategies to repair donor lungs become increasingly important. Prolonged normothermic EVLP seems to be a platform on which many reparative strategies can be realized. With these new methods for assessing and resuscitating lungs accurately, it is hoped that inroads will be made toward providing every listed patient a chance for successful lung transplantation.
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Infections of the mediastinum (ie, mediastinitis) are serious, are associated with high morbidity and mortality, and may result from adjacent disease with direct extension, hematogenous spread, or direct introduction into the mediastinal space. The organs and tissues involved determine the manifestations and approach to treatment of these infections. The most common ones are those secondary to perforation of the esophagus or penetrating trauma, and those that extend from an adjacent infection. ⋯ However, these likely represent a continuum of chronic infection. In cases of acute mediastinitis, treatment should always be directed toward the primary pathology and the clinical presentation. In chronic cases, surgical treatment is only palliative.
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Thoracic surgery clinics · Nov 2008
ReviewMinimally invasive staging of N2 disease: endobronchial ultrasound/transesophageal endoscopic ultrasound, mediastinoscopy, and thoracoscopy.
In 2005 the American College of Surgeons conducted a survey examining lung cancer practice patterns at 729 hospitals in the United States. In 11,668 surgically treated patients, 92% received a preoperative chest CT. ⋯ In the remaining 42% only the lymph node material attached to the surgical specimen (N1 nodes) was sampled. Although this article discusses the finer points of the minimally invasive evaluation of the N2 lymph nodes, any procedure to evaluate these nodes is better than simply ignoring them.
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The authors' initial experience with awake videothoracoscopic lung resection suggests that these procedures can be easily and safely performed under sole thoracic epidural anesthesia with no mortality and negligible morbidity. One major concern was that operating on a ventilating lung would render surgical maneuvers more difficult because of the lung movements and lack of a sufficient operating space. Instead, the open pneumothorax created after trocar insertion produces a satisfactory lung collapse that does not hamper surgical maneuvers. ⋯ Awake thoracic surgery will benefit from evidence-based data that are progressively accumulating. Findings will stimulate experts to continue an active clinical investigation in this unpredictably evolving surgical field, which might ultimately lead to a better understanding of cardiorespiratory physiology and effects of the surgical pneumothorax and thoracic epidural anesthesia on perioperative, respiratory function in awake patients. As the Italian architect Renzo Piano recently stated, "Recovering in the past can be reassuring but the future is the only place where we can go."