Seminars in thoracic and cardiovascular surgery
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Semin. Thorac. Cardiovasc. Surg. · Jan 2013
ReviewInvasive mediastinal staging: endobronchial ultrasound, endoscopic ultrasound, and mediastinoscopy.
Accurate mediastinal staging is essential to determining the optimal therapeutic strategy for many patients with lung cancer. Computed tomography and positron emission tomography are first steps, but frequently tissue sampling is recommended to confirm the radiographic findings. ⋯ The keys to achieving accurate results are skillful execution combined with sound clinical judgment regarding when to use which techniques. Patients with lung cancer are best served by clinicians experienced with all three methods for invasive mediastinal staging.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2013
ReviewCurrent readings: improvements in intensity-modulated radiation therapy for malignant pleural mesothelioma.
The treatment of malignant pleural mesothelioma with radiation therapy has always been a technical challenge. Early experience with intensity-modulated radiation therapy demonstrated troubling toxicity. Recent reports from institutions have demonstrated that with greater experience, intensity-modulated radiation therapy can be delivered safely, both in the setting of pneumonectomy or pleurectomy. ⋯ In the setting of 2 intact lungs, the mean lung dose can be as high as 20 Gy. Expected rates of grade 3 or worse radiation pneumonitis are 12%-20%. The rates of fatal pneumonitis are approximately 3%-8% in these studies, which demonstrate the considerable toxicity of treatment, even with improved technique.
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Modern cardiac practice in the United States is conservative when it comes to using bilateral internal mammary or radial artery grafts in coronary artery bypass surgery. Here, we examine the evidence regarding using other arterial grafts instead of veins as a complement to left internal mammary artery in surgical revascularization. In addition, we put our report in perspective relative to prevailing practice, professional societal guidelines, and future directions in coronary artery bypass grafting.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2013
Lobar lung transplantation: emerging evidence for a viable option.
The field of lung transplantation has seen an exciting evolution recently, with novel approaches to increasing the number of organs available for patients with end-stage lung disease. We review 2 recent reports describing the approach of lobar lung transplant as a successful and viable option for those recipients who are challenged by size mismatch and clinical course decline while on the transplant waiting list.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2013
Current status of left ventricular assist device technology.
The use of long-term left ventricular assist devices (LVADs) has revolutionized the treatment of end-stage heart failure. The most significant advance in this field has been the longer durability of devices secondary to a simpler pump design with fewer or no mechanical bearings and valves. ⋯ As LVAD technology moves forward and new miniaturized, more durable, and reliable pumps are being developed, the number of recipients who will benefit from this technology continues to grow. Elimination of the driveline with fully implantable pumps, implantation of miniature pumps with minimally invasive surgical techniques, wireless data transmission, and improved patient selection will further transform this field in the next few years.