Thoracic surgery clinics
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Thoracic surgery clinics · May 2007
ReviewStereotactic body radiation therapy for stage I non-small cell lung cancer.
Image-guided SBRT with the delivery of a BED greater than 100 Gy is feasible and safe in the treatment of peripherally located inoperable stage I NSCLC. The 3- to 5-year local control and overall survival rates for SBRT seem to be much better than the rates for conventional radiotherapy, and the toxicity rate is minimal. Particularly for stage Ia (T1N0M0) disease, survival rates with SBRT were comparable with rates seen with surgical resection. ⋯ Its role in operable stage I NSCLC. however. is not clear. To balance improved targeting accuracy with minimized treatment-related toxicity. a reliable immobilization device and consideration of image-guided tumor motion are crucial. The optimal dose regimen remains unclear, but a BED greater than 100 Gy seems warranted.
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Thoracic surgery clinics · Feb 2007
ReviewVideo-assisted thoracic surgical applications in thoracic trauma.
VATS is a valuable and safe way to manage many problems in thoracic trauma. It may allow earlier diagnosis and treatment of posttraumatic complications of chest injuries with less morbidity. ⋯ The reduced pain and morbidity are attractive features compared with open thoracotomy. VATS continues to evolve in thoracic trauma, but unquestionably has proved value.
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Flail chest is an uncommon consequence of blunt trauma. It usually occurs in the setting of a high-speed motor vehicle crash and can carry a high morbidity and mortality. The outcome of flail chest injury is a function of associated injuries. ⋯ There is no role for surgical stabilization for patients with severe pulmonary contusion. The underlying lung injury and respiratory failure preclude early ventilator weaning. Supportive therapy and pneumatic stabilization is the recommended approach for this patient subset.
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Tracheobronchial injuries are relatively uncommon, often require a degree of clinical suspicion to make the diagnosis, and usually require immediate management. The primary initial goals are twofold: stabilize the airway and define the extent and location of injury. These are often facilitated by flexible bronchoscopy, in the hands of a surgeon capable of managing these injuries. ⋯ The mainstay of intraoperative management remains a single-lumen endotracheal tube. Most injuries can be repaired by simple techniques, using interrupted sutures, but some require complex reconstructive techniques. Follow-up to detect stenosis or anastomotic technique is important, as is attention to pulmonary toilet.
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Thoracic surgery clinics · Feb 2007
ReviewPulmonary contusions and critical care management in thoracic trauma.
Many victims of thoracic trauma require ICU care and mechanical ventilatory support. Pressure and volume-limited modes assist in the prevention of ventilator-associated lung injury. Ventilator-associated pneumonia is a significant cause of posttraumatic morbidity and mortality. Minimizing ventilator days, secretion control, early nutritional support, and patient positioning are methods to reduce the risk of pneumonia.