Seminars in thoracic and cardiovascular surgery
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Flail chest is most often accompanied by a significant underlying pulmonary parenchymal injury and can be a life-threatening thoracic injury. Its management is often complicated by the other injuries it is frequently associated with. ⋯ In those patients requiring mechanical ventilatory support, or who require ipsilateral thoracocotomy, rib stabilization may be considered depending on a host of potentially conflicting indications and contraindications. At the end of this section are listed the current major recommendations and their levels of evidence.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2008
ReviewHyperthermic chemoperfusion for the treatment of malignant pleural mesothelioma.
Malignant pleural mesothelioma is a uniformly fatal disease with a poor prognosis. Multimodality therapy, including macroscopic complete resection, chemotherapy and/or radiotherapy, has improved survival relative to historical controls, but local recurrence remains problematic. Novel strategies are needed to improve local control. ⋯ Our experience and technique of hyperthermic IC is described. The evolution of our experience has led to the use of pharmacologic renal cytoprotection, which has permitted the safe administration of higher doses of IC than previously described. Further trials are being performed with a multidrug combination following macroscopic complete resection.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2008
ReviewThe new lung allocation system and its impact on waitlist characteristics and post-transplant outcomes.
Historically, waiting time was the primary determinant of lung organ allocation in the United States. Under this system, waiting time grew progressively longer as the annual number of transplants reached a plateau, and every year, a considerable number of candidates died while waiting. ⋯ Early evaluations of the new system indicate that waiting time has decreased, the total number of transplants has increased, waitlist mortality may be decreasing, and survival after transplantation remains unchanged. Over time, refinements in the lung allocation score will likely reduce waitlist mortality further and maintain or perhaps improve survival after transplantation.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2008
ReviewEndobronchial valves for the treatment of emphysema.
Although lung volume reduction surgery (LVRS) improves quality of life, pulmonary function, exercise ability, and even survival for selected patients, several bronchoscopic procedures are being developed to reduce the morbidity and mortality. For heterogeneous emphysema, bronchial blockers, bronchial valves, and biologic glue have been used in an attempt to emulate volume reduction. ⋯ For homogeneous emphysema, airway bypass stents seem to be effective. This article reviews the results for the current procedures under investigation.