Seminars in thoracic and cardiovascular surgery
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Multidetector computed tomography (CT) allows for an accurate, noninvasive means of evaluating tracheal anatomy and pathology. The integration of information obtained from axial images, multiplanar reformats and 3-D rendering enables precise anatomical localization of tracheal pathology, provides detailed information on surrounding structures, aids in surgical planning, and allows for assessment of posttreatment response. Although bronchoscopy remains the gold standard in the diagnosis of tracheal pathology, the proper utilization of radiologic imaging can allow for improved patient care.
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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
ReviewTargeted therapy for the treatment of non-small cell lung cancer: focus on inhibition of epidermal growth factor receptor.
Systemic chemotherapy is the standard treatment for patients with advanced stage non-small cell lung cancer (NSCLC) and improves both their survival and quality of life. Despite this, the overall prognosis for advanced NSCLC remains poor. Molecularly targeted therapies are being developed in an effort to improve outcomes for patients with advanced NSCLC. ⋯ EGFR signal may be blocked with small molecule inhibitors of the tyrosine kinase of EGFR (erlotinib, gefitinib) and with monoclonal antibodies against the ligand-binding domain (cetuximab). Erlotinib and gefitinib are in clinical use as single agents for the treatment of NSCLC and recent data suggest cetuximab improves survival when combined with chemotherapy for the treatment of metastatic NSCLC. This article reviews the role of currently available and emerging EGFR inhibitors in the treatment of NSCLC.