Seminars in thoracic and cardiovascular surgery
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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.
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The initial approach to penetrating thoracic trauma is directed towards the pathophysiologic syndrome upon presentation. Most patients are successfully treated with drainage tubes. The unstable patient may necessitate thoracotomy at the emergency room to drain cardiac tamponade, provide cardiac massage and control bleeding. ⋯ Need for further work-up of potential injuries to other mediastinal organs is frequently screened by computerized tomography. Surgery might still be needed, on a less emergent basis, in order to repair injuries to the trachea/esophagus, retained hemothorax, or to rule out diaphragmatic injury. Laparoscopic and thoracoscopic procedures may be used in specific situations.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2008
ReviewEndobronchial ultrasound-guided transbronchial needle aspiration for mediastinal lymph node staging in non-small cell lung cancer.
Mediastinoscopy is the gold standard for mediastinal lymph node (MLN) staging for non-small cell lung cancer patients; however, mediastinoscopy is invasive and allows access to a limited number of American Thoracic Society MLN stations (1, 2, 3, 4, and 7). Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is emerging as a useful, less invasive staging technique that offers access to a wider range of MLN stations (2, 3, 4, 7, 10, and 11). Although EBUS-TBNA has excellent sensitivity and diagnostic accuracy, an alternative MLN biopsy technique (i.e., mediastinoscopy or thoracoscopy) is required to confirm negative cytology findings, especially after induction therapy. Additionally, an experienced cytopathologist is critical to establishing an effective EBUS-TBNA program.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2008
ReviewContinuous-flow rotary left ventricular assist devices with "3rd generation" design.
Left ventricular assist device (LVAD) therapy has become an established treatment option for patients with advanced heart failure. Broader application of this therapy has been limited by the risk profile of the current generation of devices. The development of continuous-flow rotary pump technology with noncontact bearing design offers the promise of improved device durability and safety profile. Clinical evaluation of these innovative pump designs are currently underway.