The Annals of thoracic surgery
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Review Meta Analysis
A meta-analysis of resected metachronous second non-small cell lung cancer.
This meta-analysis was designed to determine the effect of surgical treatment on overall survival of patients treated surgically for a second non-small cell lung cancer (NSCLC) that occurred after resection of an initial NSCLC. PubMed and Scopus databases were queried. ⋯ Meta-analyses revealed pooled operative mortality of 7% for the second resection, pooled 5-year overall survival of 46% after resection of the second NSCLC, and 79% after resection of the first NSCLC. These results suggest that surgical resection can be considered for patients who have a second primary NSCLC after resection of an initial lung cancer.
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Clinical practice in the United States has no restrictions in allocating lungs from adult donors to pediatric recipients. ⋯ Adult donor lung allografts appear not to negatively affect survival in pediatric lung transplant recipients when considering confounders, and do not influence survival through an increased hazard for the development of BOS.
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Near-infrared spectroscopy (NIRS) is a noninvasive technique that allows continuous monitoring of regional hemoglobin oxygen saturation (rSo2). We evaluated its application to survey oxygenation of the spinal cord region during open thoracoabdominal aortic aneurysm (TAAA) repair and postoperatively in the intensive care unit (ICU). We also validated its association with motor-evoked potential (MEP) monitoring during the operation. ⋯ NIRS is an easily applicable noninvasive tool for continuous surveillance of oxygenation of the spinal cord region during TAAA repair and postoperatively in the intensive care unit. The rSo2 curves provide useful information concerning hemodynamic changes in oxygenation of the spinal cord region and might contribute to early detection of spinal cord ischemia. Further investigation is needed before broad clinical implementation.
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Pulmonary alveolar proteinosis (PAP) is characterized by accumulation of lipoproteinaceous material in the terminal airways. Whole lung lavage (WLL) remains the gold standard treatment but may be particularly challenging in cases of severe hypoxemia. We present a 3-step strategy that was used in a patient with PAP-associated refractory hypoxemia and that combined venovenous extracorporeal membrane oxygenation (vvECMO), double-lumen orotracheal intubation, and bilateral multisegmental sequential lavage (MSL). The procedure was well tolerated and permitted weaning from the ventilator.
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The bias against integrated thoracic surgery residency applicants during general surgery interviews.
New paradigms for training cardiothoracic surgeons have been introduced, including the integrated thoracic surgery residency. Currently, a limited number of these programs exist, and all candidates apply to both integrated thoracic and general surgery residencies. We sought to investigate the applicants' experiences applying for both types of positions. ⋯ The applicants to the integrated thoracic surgery residencies become interested in cardiothoracic surgery early and tailor their clinical education to this interest. Although they are academically successful, they report significant negativity regarding their applications to both general surgery and integrated thoracic residencies.