Thoracic Surgery Review Articles
Articles which contain the words "Thoracic Surgery" on PubMed that are classified as reviews. To search press Ctrl+F and enter word.
1: J Cardiovasc Nurs. 2003 Nov-Dec;18(5):382-8.
Robotically assisted cardiac surgery: minimally invasive techniques to
totally
endoscopic heart surgery.
Pike NA, Gundry SR.
International Heart Institute of Palm Springs, Desert Regional Medical
Center,
Palm Springs, Calif, USA. nancypikemuth@yahoo.com
Over the past decade, advancements in cardiac surgery occurred secondary to
improvements in technology and the desire for a less invasive approach to
operations in general. Minimally invasive cardiac surgery has progressed
from
partial sternotomy incisions to totally endoscopic open-heart procedures
with
robotic-assistance. There are 2 major companies that produce robotic
equipment
for use in cardiac surgery. These companies must undergo Food and Drug
Association (FDA) mandated clinical trials on each cardiac surgical
procedure,
before it can be approved for public use. The surgeon must demonstrate
clinical
proficiency to operate the robotic equipment per FDA approved company
testing.
The use of computer (robotic) enhancement is well documented for coronary
artery
bypass grafting and selected cardiac valve procedures. Recent advancements
are
now being directed at congenital heart disease. The use of robotic-assisted
totally endoscopic atrial septal defect closure is a tremendous advancement
in
congenital cardiac surgery. The future of robotic cardiac surgery will
hopefully
expand to cover more advanced valve procedures, congenital heart defects,
and
other procedures once robots are further modified for pediatric use.
Publication Types:
Review
Review, Tutorial
PMID: 14680342 [PubMed - indexed for MEDLINE]
2: JAMA. 2003 Nov 12;290(18):2455-63.
Efficacy of postoperative epidural analgesia: a meta-analysis.
Block BM, Liu SS, Rowlingson AJ, Cowan AR, Cowan JA Jr, Wu CL.
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins
University, Baltimore, Md 21287, USA.
CONTEXT: Whether epidural analgesia is a better method than parenteral
opioids
for postoperative pain control remains controversial. OBJECTIVE: To
systematically review the efficacy of postoperative epidural analgesia vs
parenteral opioids, the primary alternative technique. DATA SOURCES: Studies
were identified primarily by searching the National Library of Medicine's
PubMed
database (1966 to April 25, 2002) and other sources for studies related to
postoperative epidural analgesia. STUDY SELECTION: Inclusion criteria were a
comparison of epidural therapy vs parenteral opioids for postoperative
analgesia, measurement of pain using a visual analog scale (VAS) or numeric
rating scale, randomization of patients to either therapy, and adult
patients (>
or =18 years). A total of 1404 abstracts were identified, 100 of which met
all
inclusion criteria. DATA EXTRACTION: Each article was reviewed and data
extracted from tables, text, or extrapolated from figures as needed.
Weighted
mean pain scores, weighted mean differences in pain score, and weighted
incidences of complications were determined by using a fixed-effect model.
DATA
SYNTHESIS: Epidural analgesia provided better postoperative analgesia
compared
with parenteral opioids (mean [SE], 19.40 mm [0.17] vs 29.40 mm [0.20] on
the
VAS; P<.001). When analyzed by postoperative day, epidural analgesia was better
than parenteral opioids on each postoperative day (P<.001 for each day
after
surgery). For all types of surgery and pain assessments, all forms of
epidural
analgesia provided significantly better postoperative analgesia compared
with
parenteral opioid analgesia (P<.001 for all), with the exception of
thoracic
epidural analgesia vs opioids for rest pain after thoracic surgery (weighted
mean difference, 0.6 mm; 95% confidence interval, -0.3 to 1.5 mm; P =.12).
The
complication rates were lower than expected for nausea or vomiting and
pruritus
but comparable with existing data for lower extremity motor block.
CONCLUSION:
Epidural analgesia, regardless of analgesic agent, location of catheter
placement, and type and time of pain assessment, provided better
postoperative
analgesia compared with parenteral opioids.
Publication Types:
Meta-Analysis
Review
Review, Academic
PMID: 14612482 [PubMed - indexed for MEDLINE]
3: Thorax. 2003 Nov;58(11):996-7.
Lung cancer . 10: Delivering a lung cancer service in the 21st century.
Wells FC.
Cardiothoracic Surgery, Papworth Hospital, Papworth Everard, Cambridge CB3
8RE,
UK.
Properly organised regional centres would involve teams of interested
cardiothoracic surgeons working with, and possibly led by, specialist pure
thoracic surgeons to common protocols. A great deal of time would be saved
by
specialist staff reducing travelling times to outlying units. Data
collection
and administration would be greatly enhanced and the potential for
collaborative
work significantly increased. Unfortunately, there has been little if any
coherent planning for a national strategy for the delivery of such care in
the
United Kingdom.
Publication Types:
Review
Review, Tutorial
PMID: 14586057 [PubMed - indexed for MEDLINE]
4: J Thorac Cardiovasc Surg. 2003 Oct;126(4):1204-7.
Combined endovascular and video-assisted thoracoscopic procedure for
treatment
of a ruptured pulmonary arteriovenous fistula: Case report and review of the
literature.
Litzler PY, Douvrin F, Bouchart F, Tabley A, Lemercier E, Baste JM, Redonnet
M,
Haas-Hubscher C, Clavier E, Bessou JP.
Department of Thoracic and Cardiovascular Surgery, Rouen University
Hospital-Charles Nicolle, Rouen, France. pierre-yves.litzler@chu-rouen.fr
Publication Types:
Case Reports
Review
Review of Reported
Cases
PMID: 14566278 [PubMed - indexed for MEDLINE]
5: Ann Thorac Surg. 2003 Oct;76(4):1279-81.
Papillary adenocarcinoma in a thymic cyst: a pitfall of thoracoscopic
excision.
Zaitlin N, Rozenman J, Yellin A.
Department of Thoracic Surgery and Diagnostic Radiology, The Chaim Sheba
Medical
Center, Tel-Aviv University Sackler School of Medicine, Tel-Hashomer,
Israel.
Carcinoma arising in a thymic cyst is very rare. We performed thoracoscopic
subtotal resection of an assumed benign cyst. The patient had a reoperation
when
the diagnosis of papillary adenocarcinoma was established. Complete
resection
and pleural thermochemotherapy were performed. The patient died 26 months
later
from systemic metastases. Caution must be exercised when managing nontypical
thymic cysts.
Publication Types:
Case Reports
Review
Review of Reported
Cases
PMID: 14530028 [PubMed - indexed for MEDLINE]
6: Arch Dis Child. 2003 Oct;88(10):839-41.
Comment on:
Arch Dis Child.
2003 Oct;88(10):918-21.
Thoracic empyema.
Jaffe A, Cohen G.
Portex Respiratory Medicine Unit, Great Ormond Street Hospital for Children
NHS
Trust and Institute of Child Health, Great Ormond Street, London WC1N 3JH,
UK.
a.jaffe@ich.ucl.ac.uk
Publication Types:
Comment
Review
Review, Tutorial
PMID: 14500294 [PubMed - indexed for MEDLINE]
7: J Surg Oncol. 2003 Sep;84(1):1-6.
Surgical considerations with lung cancer screening.
Warner EE, Mulshine JL.
Publication Types:
Editorial
Review
Review, Tutorial
PMID: 12949983 [PubMed - indexed for MEDLINE]
8: Respir Care Clin N Am. 2003 Jun;9(2):191-205.
Combined modality therapy of early stage nonsmall cell lung cancer.
Pisters KM.
Department of Thoracic/Head & Neck Medical Oncology, University of
Texas, M. D.
Anderson Cancer Center, Box 432, Houston, TX 77030, USA.
kpisters@mdanderson.org
Therapy for locally advanced NSCLC has evolved into a multidisciplinary
effort.
Patients who are considered for this approach should undergo rigorous
testing to
accurately stage their disease. Patients with pleural effusions (with rare
exception) are not candidates for intensive combined modality therapy.
Appropriate patients for combined modality therapy should have a good
performance status (generally Zubrod 0 or 1), adequate pulmonary function,
absence of significant heart, lung, or other medical diseases, and be
appropriate candidates for combination chemotherapy and thoracic surgery or
thoracic radiotherapy. Several lessons can be learned from looking broadly
at
the phase II and phase III combined modality experience. The available data
do
not support the routine use of postoperative therapy in patients with
completely
resected disease. Treatment with chemotherapy before surgery or radiation
has
demonstrated survival benefit in patients with stage III disease. The French
phase III trial of induction chemotherapy in patients with early stage
disease
found an 11-month improvement in overall survival (P = 0.15) and a
significant
increase in the risk of death for patients with stage I and II disease. The
ongoing U.S. intergroup trial (SWOG 9900) and European trials will help to
further define the role of chemotherapy in patients with clinical stage IB,
II
and IIIA NSCLC. Clinical trials should be conducted to compare preoperative
chemoradiotherapy with preoperative chemotherapy. The recently completed
intergroup 0139 trial (chemoradiation followed by surgery or not) should
help to
define whether surgery and radiation are required in the management of stage
IIIA NSCLC. Finally, further improvement in survival with the use of
"newer"
cytotoxic agents seems unlikely as phase III trials in metastatic NSCLC have
not
demonstrated marked superiority over cispiatin-based regimens. Ongoing
trials
are assessing the incorporation of newer, biologic-based
"targeted" therapies.
Despite the dismal findings of trials of postoperative therapy, many
patients
continue to have surgery as their initial treatment followed by
postoperative
therapy. In contrast, trials with induction treatment seem to offer improved
survival. It is time for a true multidisciplinary approach to the treatment
of
locally advanced NSCLC. Pulmonary physicians, thoracic surgeons, medical
oncologists, and radiation oncologists should meet before the initiation of
treatment to plan the most appropriate therapy for the individual patient.
Publication Types:
Review
Review, Tutorial
PMID: 12911289 [PubMed - indexed for MEDLINE]
9: Ann Thorac Surg. 2003 Jul;76(1):4-11.
Assessing the medical literature: let the buyer beware.
Ferraris VA, Ferraris SP.
Division of Cardiovascular and Thoracic Surgery, University of Kentucky
Chandler
Medical Center, Lexington, Kentucky 40536, USA. vferr2@uky.edu
As many as 30% of journal articles may contain errors. Most of these errors
involve the use of simple statistical tests or elementary principles of
research
design. Assessment of the thoracic surgical literature involves cautious
circumspection. This does not mean that it is necessary to have in-depth
knowledge of sophisticated statistics, rather it means that common sense
understanding of a few principles of research design and simple statistics
are
necessary to determine the usefulness and believability of literature
publications.
Publication Types:
Review
Review, Tutorial
PMID: 12842503 [PubMed - indexed for MEDLINE]
10: N Engl J Med. 2003 Jun 19;348(25):2535-42.
Comment in:
N Engl J Med. 2003
Oct 16;349(16):1575; author reply 1575.
Clinical practice. The solitary pulmonary nodule.
Ost D, Fein AM, Feinsilver SH.
Center for Pulmonary and Critical Care Medicine, North Shore University
Hospital, Manhasset, NY 11030, USA. dost@nshs.edu
Publication Types:
Case Reports
Review
Review, Tutorial
PMID: 12815140 [PubMed - indexed for MEDLINE]
11: Semin Thorac Cardiovasc Surg. 2003 Jan;15(1):35-43.
Minimally invasive techniques for resection of benign esophageal tumors.
Samphire J, Nafteux P, Luketich J.
Division of Thoracic and Foregut Surgery, UPMC Presbyterian, Pittsburgh, PA
15213, USA.
With the emergence of minimally invasive surgery (MIS), laparoscopy and
thoracoscopy have become feasible and safe alternatives to open surgical
procedures in the management of esophageal leiomyomas. The indications for
MIS
resection of leiomyomas at our institution include the presence of symptoms,
confirmation of pathology to exclude malignancy, tumors greater than 2 cm in
size or tumors that show evidence of growth. Our approach of choice is right
video-assisted thoracoscopic surgery (VATS) for tumors of the thoracic
esophagus
and laparoscopy for tumors of the intra-abdominal esophagus or
gastroesophageal
junction. A detailed description of these surgical approaches is outlined in
the
following chapter. At our institution, nine patients, 8 males and 2 females
with
a mean age of 54 years (range 42-67 years) had a minimally invasive surgical
resection of an esophageal leiomyoma between 1995 and 2001. The surgical
approaches included right VATS enucleation (6) and laparoscopic enucleation
(3).
There were no major morbidities, including postoperative leaks or
mortalities.
The mean hospital stay was 2.3 days. All tumors were benign leiomyomas with
average size of 2.73 cm (range 0.9-8 cm) and there was no evidence of
recurrence
at a mean follow-up of 10 months. Video-assisted enucleation has shown in
our
institution, as well as in others, that the procedure can be performed
safely
with low mortality and morbidity. A VATS or laparoscopic approach to the
removal
of leiomyomas should be the treatment of choice in centers experienced in
minimally invasive surgery. Copyright 2003 Elsevier Inc. All rights
reserved.
Publication Types:
Review
Review, Tutorial
PMID: 12813687 [PubMed - indexed for MEDLINE]
12: J Am Coll Surg. 2003 May;196(5):768-77.
What's new in cardiac surgery.
Sundt TM.
Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN 55905, USA.
Publication Types:
Review
Review, Tutorial
PMID: 12742211 [PubMed - indexed for MEDLINE]
13: J Bone Joint Surg Am. 2003 May;85-A(5):956-61.
An AOA critical issue. Less invasive procedures in spine surgery.
Hanley E, Green NE, Spengler DM; American Orthopaedic Association.
Department of Orthopaedics, Carolinas Medical Center, Charlotte, NC 28203,
USA.
Publication Types:
Review
Review, Tutorial
PMID: 12728049 [PubMed - indexed for MEDLINE]
14: Clin Radiol. 2003 May;58(5):341-50.
Complications of tracheal and thoracic surgery: the role of multisection
helical
CT and computerized reformations.
Konen E, Yellin A, Greenberg I, Paley M, Shulimzon T, Wolf M, Reichert N,
Itzchak Y, Rozenman J.
Department of Diagnostic Imaging, The Chaim Sheba Medical Center, Affiliated
with The Sackler School of Medicine, Tel-Aviv University, Tel Hashomer,
Israel.
konen@sympatico.ca
Helical computed tomography (CT) has an important role in the evaluation of
a
wide range of congenital and acquired thoracic abnormalities. The
development of
advanced computerized reformations enables the generation of bronchographic
and
bronchoscopic images of the tracheobronchial tree, as well as angiographic
images of pulmonary arteries and veins. Additionally, it provides coronal
and
sagittal reconstruction imaging of parenchymal abnormalities. This
information
is obtained by a 20-30s procedure on a typical single channel system, which
makes helical CT an optimal technique for the evaluation of patients
undergoing
major upper airways and thoracic interventions. The recent introduction of
multisection CT scanners allows faster imaging of patients with thinner
collimation, thus improving spatial resolution along the longitudinal (z)
axis
of the patient along with reduction of motion artefacts. This article
demonstrates the use of dual and quad-section helical CT in the
postoperative
evaluation of patients undergoing laryngo-tracheal and thoracic
interventions,
including laryngoplasty, tracheal endoscopic laser ablation, lobectomy,
pneumonectomy, lung transplantation, sleeve resection, pulmonary
angioplasty,
and pulmonary artery thromboendarterectomy. Emphasis is given to the
additive
value of using computerized reformations over axial images, especially for
delineation of complex postoperative anatomical details in the
tracheobronchial
tree and pulmonary vasculature.
Publication Types:
Review
Review, Tutorial
PMID: 12727161 [PubMed - indexed for MEDLINE]
15: J Cardiovasc Electrophysiol. 2003 Feb;14(2):127-32.
Temporary atrial epicardial pacing as prophylaxis against atrial
fibrillation
after heart surgery: a meta-analysis.
Daoud EG, Snow R, Hummel JD, Kalbfleisch SJ, Weiss R, Augostini R.
MidOhio Cardiology and Vascular Consultants, MidWest Research Foundation,
and
Riverside-Methodist Hospital, Columbus, Ohio, USA. egd@mocc.cc
INTRODUCTION: Recent studies have reported the use of temporary epicardial
atrial pacing as prophylaxis for postoperative atrial fibrillation (AF). The
aim
of this study was to assess the effect of pacing therapies for prevention of
postoperative AF using meta-analysis. METHODS AND RESULTS: Using a
computerized
MEDLINE search, eight pacing prophylaxis trials with 776 patients were
included
in the meta-analysis. Trials compared control patients to patients
randomized to
right atrial, left atrial, or biatrial pacing used in conjunction with
either
fixed high-rate pacing or overdrive pacing. Overdrive biatrial pacing (OR
2.6,
CI 1.4-4.8), overdrive right atrial pacing (OR 1.8, CI 1.1-2.7), and fixed
high-rate biatrial pacing (OR 2.5, CI 1.3-5.1) demonstrated a significant
antiarrhythmic effect for prevention of AF after open heart surgery.
Furthermore, studies investigating overdrive left atrial pacing and fixed
high-rate right atrial pacing have been underpowered to assess efficacy.
CONCLUSION: Biatrial overdrive and fixed high-rate pacing and right atrial
fixed
high-rate pacing reduced the risk of new-onset AF after open heart surgery,
and
the relative risk reduction is approximately 2.5-fold. These results imply
that
various pacing algorithms are useful as a nonpharmacologic method to prevent
postoperative AF.
Publication Types:
Meta-Analysis
Review
Review, Academic
PMID: 12693490 [PubMed - indexed for MEDLINE]
16: Ann Thorac Surg. 2003 Apr;75(4):1340-8.
Cardiac complications after noncardiac thoracic surgery: an evidence-based
current review.
De Decker K, Jorens PG, Van Schil P.
Department of Intensive Care Medicine, Antwerp University Hospital, Edegem,
Belgium. koen.de.decker@uza.be
Despite advances in perioperative management, thoracic surgery remains a
high-risk procedure for many patients. A systematic review of cardiac
complications after thoracic surgery is presented. Most reviews about
noncardiac
thoracic surgery discuss postoperative analgesic regimens and pulmonary
complications. In the present review, we also discuss atrial fibrillation as
the
most frequently encountered cardiac side effect. An evidence-based approach
to
other complications, such as myocardial ischemia, pulmonary edema, embolism,
and
shunt, is described. Furthermore, we offer recommendations for daily
practice.
Publication Types:
Review
Review Literature
PMID: 12683600 [PubMed - indexed for MEDLINE]
17: J Interv Cardiol. 2003 Feb;16(1):93-6.
Percutaneous mitral valve repair for mitral regurgitation.
Block PC.
Emory University Hospital, Atlanta, Georgia, USA.
Mitral regurgitation (MR) associated with, ischemic, and degenerative
(prolapse)
disease, contributes to left ventricular (LV) dysfunction due to remodeling,
and
LV dilation, resulting in worsening of MR. Mitral valve (MV) surgical repair
has
provided improvement in survival, LV function and symptoms, especially when
performed early. Surgical repair is complex, due to diverse etiologies and
has
significant complications. The Society for Thoracic Surgery database shows
that
operative mortality for a 1st repair is 2% and for re-do repair is 4 times
that.
Cardiopulmonary bypass and cardiac arrest are required. The attendant
morbidity
prolongs hospitalization and recovery. Alfieri simplified mitral repair
using an
edge-to-edge technique which subsequently has been shown to be effective for
multiple etiologies of MR. The MV leaflers are typically brought together by
a
central suture producing a double orifice MV without stenosis. Umana
reported
that MR decreased from grade 3.6 +/- 0.5 to 0.8 +/- 0.4 (P < 0.0001) and
LV
ejection fraction increased from 33 +/- 13% to 45 +/- 11% (P = 0.0156). In
121
patients, Maisano reported freedom from re-operation of 95 +/- 4.8% with up
to 6
year follow-up. Oz developed a MV "grasper" that is directly
placed via a left
ventriculotomy and coapts both leaflets which are then fastened by a
graduated
spiral screw. An in-vitro model using explanted human valves showed
significant
reduction in MR and in canine studies, animals followed by serial echo had
persistent MV coaptation. At 12 weeks the device was endothelialized. These
promising results have paved the way for a percutaneous or minimally
invasive-off pump mitral repair. Evalve has developed catheter-based
technology,
which, by apposing the edges of a regurgitant MV, results in edge-to-edge
repair. Release of the device is done after echo and fluoroscopic evaluation
under normal loading conditions. If the desired effect is not produced the
device can be repositioned or retrieved. Animal studies show excellent
healing,
with incorporation of the device into the leaflets at 6-10 weeks with
persistent
coaptation. Another percutaneous approach has been to utilize the proximity
of
the coronary sinus (CS) to the mitral annulus (MA). Placement of a
self-compressing device in the CS along the region of the posterior MA has,
in
canine models, reduced MR and addresses the issues of MA dilation and its
contribution to MR. Ongoing studies are underway for both techniques.
Publication Types:
Review
Review, Tutorial
PMID: 12664822 [PubMed - indexed for MEDLINE]
18: Semin Thorac Cardiovasc Surg. 2002 Oct;14(4):391-8.
Technical issues and controversies in lung volume reduction surgery.
DeCamp MM Jr.
Section of Lung Transplantation, Department of Thoracic and Cardiovascular
Surgery, The Cleveland Clinic Foundation, OH 44195, USA.
The goal of lung volume reduction surgery (LVRS) is to safely palliate
dyspnea
in patients suffering from emphysema. Successful LVRS demands attention to
the
details of patient selection, preoperative preparation, intraoperative
anesthetic and surgical technique and multidisciplinary postoperative care.
Expertise in and effective communication between pulmonary medicine,
thoracic
surgery, thoracic anesthesia, pain management services, critical care
medicine,
respiratory therapy and rehabilitation medicine are vital components to any
LVRS
program. In experienced centers, bilateral approaches yield nearly twice the
physiologic benefit to unilateral LVRS without adversely affecting operative
morbidity or mortality. Current practice favors stapled resection over laser
ablation to achieve volume reduction. Controversy persists regarding open
versus
video-assisted operations. The cost-effective need for and choice of
materials
to buttress staple-lines to reduce the incidence of postoperative air leak
have
yet to be defined. Ongoing multi-center, randomized, controlled trials
should
define the utility and durability of LVRS for appropriately selected
patients
and resolve some of the residual technical controversies. Therapeutic
innovations may further reduce the invasiveness of lung volume reduction
strategies and allow a more tailored approach to palliate patients with
moderate
to severe emphysema. Copyright 2002, Elsevier Science (USA). All rights
reserved.
Publication Types:
Review
Review, Tutorial
PMID: 12652444 [PubMed - indexed for MEDLINE]
19: Semin Thorac Cardiovasc Surg. 2002 Oct;14(4):354-7.
Aortic surgery in Asia.
Lee CN, Sin YK.
The Heart Institute, Singapore.
Aortic Surgery in Asia is in markedly different stages of development. We
assessed the approximate state in some Asian countries. Personal
communications
are sought from Asian surgeons known to have interest in aortic surgery.
Copyright 2002, Elsevier Science (USA). All rights reserved.
Publication Types:
Review
Review, Tutorial
PMID: 12652438 [PubMed - indexed for MEDLINE]
20: Swiss Med Wkly. 2003 Jan 11;133(1-2):4-8.
Advances in thoracic surgery : emphysema and simultaneous bronchial
carcinoma.
Pezzetta E, Fitting JW, Ris HB.
Service de Chirurgie, Centre Hospitalier Universitaire Vaudois, Lausanne.
EdgardoPezzeta@chuv.hospvd.ch
Publication Types:
Review
Review, Tutorial
PMID: 12596089 [PubMed - indexed for MEDLINE]
21: Eur Respir J Suppl. 2003 Jan;39:57s-66s.
New techniques for early detection of lung cancer.
Sutedja G.
Dept of Pulmonology, Vrije Universiteit Medical Center, Amsterdam, The
Netherlands. tg.sutedja@vumc.nl
The resurgence of interest in lung cancer screening and the application of
new
techniques for the management of early cancer have raised various issues
regarding this global epidemic. In previous randomised clinical trials, the
use
of conventional chest radiographs and sputum cytology examinations for
screening
have been shown not to reduce lung cancer mortality. The use of biomolecular
markers, autofluorescence bronchoscopy, low-dose spiral and high-resolution
computed tomography, endobronchial ultrasonography, optical coherence
tomography, confocal micro-endoscopy, positron emission tomography in
combination with video-assisted thoracic surgery and intraluminal
bronchoscopic
treatments may provide new modalities with which to manage lung cancer at
the
earliest stage possible. New hopes arise that the combined use of more
accurate
and minimally invasive diagnostic and treatment techniques may justify
screening
and reduce mortality. More individuals may also benefit, as many in the
target
population already suffer from poor cardiovascular and pulmonary health due
to
their smoking history and are considered at risk for surgical intervention.
The
cost-effectiveness of lung cancer screening will strongly depend on the
proper
selection of the target population and the optimal application of these new
techniques. Despite epidemiological controversy regarding lung cancer
screening,
the feasibility to define more precisely who are at risk and the use of less
invasive techniques may preserve quality of life and improve the survival of
many lung cancer patients.
Publication Types:
Review
Review, Academic
PMID: 12572703 [PubMed - indexed for MEDLINE]
22: Chest. 2003 Jan;123(1):280-2.
Thoracoscopic resection of Castleman disease: case report and review.
Seirafi PA, Ferguson E, Edwards FH.
Division of Cardiothoracic Surgery, University of Florida-Shands
Jacksonville,
Jacksonville, FL, USA. peter.seirafi@jax.ufl.edu
Castleman disease is an uncommon entity, most often occurring in patients
presenting with localized mediastinal lymph node enlargement. While surgical
resection is the preferred treatment, there are concerns about approaching
this
highly vascular tumor with thoracoscopy. We present the second reported case
of
thoracoscopic resection of a patient with Castleman disease and review the
literature.
Publication Types:
Case Reports
Review
Review of Reported
Cases
PMID: 12527632 [PubMed - indexed for MEDLINE]
23: Curr Clin Top Infect Dis. 2002;22:196-213.
Diagnosis and management of empyema.
Vikram HR, Quagliarello VJ.
Department of Internal Medicine, Section of Infectious Diseases, Department
of
Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.
Publication Types:
Review
Review, Tutorial
PMID: 12520655 [PubMed - indexed for MEDLINE]
24: Int J Clin Pract. 2002 Dec;56(10):777-82.
The physiology and emerging roles of antidiuretic hormone.
Singh Ranger G.
St George's Hospital and Medical School, London, UK.
The antidiuretic hormone (ADH) vasopressin is a simple peptide hormone with
a
number of complex, essential physiological actions. It is becoming clear
that
this hormone is developing an important therapeutic role in a number of
different conditions. These include vasodilatory shock due to sepsis or cardiac
surgery, cardiac arrest, and prolonged/excessive bleeding caused by, for
example, variceal haemorrhage. This article reviews the physiology of ADH
relevant to these actions and scrutinises the evidence for its therapeutic
applications.
Publication Types:
Review
Review, Tutorial
PMID: 12510952 [PubMed - indexed for MEDLINE]
25: Eur J Radiol. 2003 Jan;45(1):39-48.
Bronchoscopy and surgical staging procedures and their correlation with
imaging.
Traill ZC, Gleeson FV.
Radiology Department, Churchill Hospital, Old Road, Headington, Oxford OX3
7LJ,
UK.
Bronchoscopy, computed tomography (CT) and surgical staging procedures are
complimentary methods of investigating patients with lung cancer. CT has
been
shown to be of value prior to bronchoscopy in the investigation of
haemoptysis
and malignancy, with excellent correlation between the detection of disease
within the large airways on CT and direct visualisation at bronchoscopy. The
utility of CT has been further increased by the development of multislice
scanners with the generation of volumetric data enabling multiplanar image
acquisition. Additionally the advent of CT co-registered with positron
emission
tomography will play an important role in guiding the choice of surgical staging
procedures The increasing use of multidisciplinary medical care requires
radiologists to have a greater understanding of the abilities and
limitations of
both bronchoscopy and surgical staging procedures in evaluating disease
demonstrated on imaging.
Publication Types:
Review
Review, Academic
PMID: 12499063 [PubMed - indexed for MEDLINE]
26: Semin Pediatr Infect Dis. 2002 Oct;13(4):280-8.
Current issues in the diagnosis and management of pediatric empyema.
Lewis RA, Feigin RD.
Department of Pediatrics, Children's Hospital of New York-Presbyterian, New
York, NY 10032, USA. rchelewis@post.harvard.edu
Empyema is a rare but recognized complication of bacterial pneumonia in
children. The incidence of empyema may be rising as vaccination practices
and
antibiotic prescribing practices promote the emergence of more virulent and
resistant organisms. Diagnostic methods vary widely, from thoracentesis to
plain
radiographs to detailed computed tomography scans. Treatment practices also
vary, with some practitioners preferring medical treatment, others employing
chest tube drainage or fibrinolytic therapy, and still others aggressively
pursuing surgical options. Further study is needed to define the ideal
management of empyema. The authors review the current literature and propose
an
updated management algorithm that incorporates accepted practices as well as
emerging trends in diagnosis and management of empyema. Copyright 2002,
Elsevier
Science (USA). All rights reserved.
Publication Types:
Review
Review, Tutorial
PMID: 12491234 [PubMed - indexed for MEDLINE]
27: Biomed Pharmacother. 2002;56 Suppl 1:187s-191s.
Overview: video-assisted breast surgery.
Tamaki Y, Tsukamoto F, Miyoshi Y, Tanji Y, Taguchi T, Noguchi S.
Department of Surgical Oncology, Graduate School of Medicine, Osaka
University,
2-2-E10, Yamadaoka, Suita, Osaka 565-0871, Japan.
tamaki@onsurg.med.osaka-u.ac.jp
Since 1992, video-assisted surgery for the breast has been developed mainly
in
the field of plastic surgery, notably in breast augmentation surgery. Today,
video-assisted surgery, indicating partial or total endoscopic surgery, can
be
performed for the treatment of both benign and malignant breast tumors to
improve the cosmetic outcome. Although, in some respects, this kind of
surgery
for malignant tumors is still experimental, it is feasible enough for
clinical
use, and is expected to become one of the standard operations for breast
cancer.
Publication Types:
Review
Review, Tutorial
PMID: 12487279 [PubMed - indexed for MEDLINE]
28: Biomed Pharmacother. 2002;56 Suppl 1:68s-71s.
Total video endoscopic thyroidectomy via the anterior chest approach using
the
cervical region-lifting method.
Kataoka H, Kitano H, Takeuchi E, Fujimura M.
Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine,
Tottori University, 36-1 Nishimachi Yonago, Tottori 683-8504, Japan.
hkataoka@grape.med.tottori-u.ac.jp
Endoscopic surgery offers superior cosmetic results compared to open
procedures
and is strongly preferred by many patients, especially women. We performed
total
endoscopic thyroidectomy via the anterior chest approach using a neck
skin-lifting technique in which the skin is lifted by a large number of
hooks to
create the working space. This method is quite flexible and can be modified
based on the size of the space needed. The fine hooks leave no scar on the
anterior neck, the skin incisions are small, and the scars are completely
covered by patients' undergarments. Endoscopic thyroidectomy is suitable for
benign thyroid nodules, but some malignant foci diagnosed by frozen section
usually can be managed without conversion to an open procedure. Women under
45
years of age with nodules <2 cm who have no evidence of lymphatic spread
or
local invasion are ideal candidates for this procedure.
Publication Types:
Review
Review Literature
PMID: 12487256 [PubMed - indexed for MEDLINE]
29: Chest. 2002 Dec;122(6):2252-6.
Subarachnoid pleural fistula due to penetrating trauma: case report and
review
of the literature.
Lloyd C, Sahn SA.
Division of Pulmonary and Critical Care Medicine, Allergy and Clinical
Immunology, Medical University of South Carolina, 96 Jonathan LucasStreet,
Suite
812, PO Box 250623, Charleston, SC 29425, USA.
We describe a case of a 30-year-old man who developed a recurrent pleural
effusion after sustaining a gunshot wound to the left side of his chest with
subsequent complete paralysis at the T2 level. Subarachnoid-pleural fistulas
have rarely been reported as complications of penetrating and blunt trauma,
thoracic surgery, as well as spinal surgery. Concomitant injuries may
overshadow
or complicate the diagnosis of subarachnoid-pleural fistulas. The diagnosis
should be considered in any patient with a pleural effusion that is
associated
with severe neurologic injury, as the fistula rarely heals without surgical
intervention and may lead to CNS infection or pneumocephalus.
Publication Types:
Case Reports
Review
Review of Reported
Cases
PMID: 12475874 [PubMed - indexed for MEDLINE]
30: Surg Clin North Am. 2002 Aug;82(4):849-65.
Acute and chronic pain syndromes after thoracic surgery.
Hazelrigg SR, Cetindag IB, Fullerton J.
Division of Cardiothoracic Surgery, Southern Illinois University School of
Medicine, 800 North Rutledge, Room D314, P.O. Box 19638, Springfield, IL
62794-9638, USA. shazelrigg@siumed.edu
Pain is one of the most important considerations in the care of thoracic
surgical patients. Failure in pain management is associated with increased
mortality and morbidity. Acute pain management aspires to stop the painful
stimuli before it is transferred to the CNS. The authors recommend (1) a
thorough explanation of the operation and the expected outcome to the
patient,
(2) preoperative pulmonary rehabilitation for those with marginal lung
function,
(3) choosing the least painful surgical approach with acceptable exposure,
(4)
minimizing tissue trauma during surgery, (5) preemptive analgesia, and (6)
early
ambulation as prophylactic measures that should be employed during
hospitalization. Good acute pain control should reduce the incidence of
chronic
pain. Mediansternotomy and VATS seem to be less acutely painful approaches
than
thoracotomy for most thoracic surgery. One should rule out recurrent
malignancy
as the etiology for chronic or recurrent pain. Opioids and NSAIDs are
sufficient
to produce optimal pain control in patients who undergo VATS and sternotomv.
TEA
is typically reserved for patients who have a thoracotomy. Opioid PCA can be
used instead of-or after the discontinuation of-the epidural catheter.
Chronic
pain can be treated in many ways, and input from a pain clinic might be
beneficial. The single best approach to chronic pain is to prevent it. This
can
be achieved by selecting the right incisional approach, instituting early
physical therapy, and achieving optimal postoperative pain control.
Publication Types:
Review
Review, Tutorial
PMID: 12472133 [PubMed - indexed for MEDLINE]
31: Chest Surg Clin N Am. 2002 Nov;12(4):659-64, vi.
Presentation and management of benign mediastinal teratomas.
Allen MS.
Department of Surgery, Mayo Clinic, 200 First Street, SW, Rochester, MN
55905,
USA. allen.mark@mayo.edu
Mediastinal teratomas are uncommon, making up only about five to ten percent
of
all mediastinal tumors and are thought to occur in approximately 1 in 3400
hospital admissions. There are many names for this tumor, but the term
"benign
teratoma" is fitting. The word "teratoma" is derived from the
Greek word
"teras", meaning monsters. They have been defined as "tumors
that are composed
of tissue that is foreign to the organ or anatomic site in which they
arise"
Alternatively, mediastinal teratomas may arise from cells adjacent to the
third
or fourth brachial cleft. Whatever the cell of origin, these tumors have
potential to express all three of the germ cell layers, ectoderm, mesoderm
and
neuroderm.
Publication Types:
Review
Review, Tutorial
PMID: 12471869 [PubMed - indexed for MEDLINE]
32: Ann Vasc Surg. 2002 Nov;16(6):708-13. Epub 2002 Nov 07.
Video-assisted thoracoscopic sympathectomy for palmar hyperhidrosis: results
in
102 cases.
Alric P, Branchereau P, Berthet JP, Leger P, Mary H, Mary-Ane C.
Service de Chirurgie Thoracique et Vasculaire, Hopital Arnaud de Villeneuve,
12
rue du Cheval Vert, 34000 Montpellier, France. cinacs@mcmaster.ca
The purpose of this retrospective study was to evaluate the immediate and
long-term outcome of video-assisted thoracoscopic sympathectomy for
idiopathic
palmar hyperhidrosis. Between January 1996 and December 2000, a total of 67
patients underwent 102 sympathectomy procedures with excision of the
sympathetic
chain between the second and fourth sympathetic ganglion. The mean duration
of
hospitalization was 1.7 +/- 0.6 days. Five patients were lost to follow-up.
Mean
duration of follow-up for the 96 sympathectomy procedures in the remaining
62
patients was 38 +/- 6.3 months. Patient outcome showed that video-assisted
thoracoscopic sympathectomy is the treatment of choice for idiopathic palmar
hyperhidrosis. Long-term patient satisfaction is excellent.
Publication Types:
Evaluation Studies
Review
Review of Reported
Cases
PMID: 12417930 [PubMed - indexed for MEDLINE]
33: Drugs. 2002;62(15):2283-314.
Danaparoid: a review of its use in thromboembolic and coagulation disorders.
Ibbotson T, Perry CM.
Adis International Limited, Mairangi Bay, Auckland, New Zealand.
demail@adis.co.nz
Danaparoid (danaparoid sodium) is a low molecular weight heparinoid which
has
undergone clinical study for use as continued anticoagulant therapy in
patients
with heparin-induced thrombocytopenia (HIT), for the prophylaxis and
treatment
of deep vein thrombosis (DVT), and for the treatment of disseminated
intravascular coagulation (DIC). A nonblind study in patients with HIT has
reported that complete clinical resolution is significantly more likely in
patients receiving danaparoid than in patients receiving dextran 70. In
addition, retrospective analyses and noncomparative data support the use of
danaparoid for continued anticoagulant therapy in patients with HIT. Studies
in
patients undergoing hip surgery have shown that danaparoid significantly
reduces
the incidence of postoperative DVT compared with aspirin, warfarin, dextran
70
and heparin-dihydroergotamine, while additional data suggest no difference
between danaparoid, enoxaparin and dalteparin. In patients undergoing
abdominal
or thoracic surgery for removal of a malignancy, danaparoid reduced the
incidence of postoperative DVT compared with placebo, but showed no
significant
difference when compared with unfractionated heparin (UFH). Two studies have
compared danaparoid with UFH in the prophylaxis of DVT following acute
ischaemic
stroke; twice daily danaparoid was significantly superior to UFH whereas
there
was no significant difference between a once-daily dosage and UFH.
Danaparoid
did not differ from UFH in terms of efficacy in the treatment of existing
DVT.
In all comparative studies examining the efficacy of danaparoid in the
prophylaxis or treatment of DVT (versus warfarin, dextran 70, enoxaparin,
dalteparin, aspirin, heparin-dihydroergotamine, UFH and placebo), the
incidence
of haemorrhagic complications did not differ between treatment groups. In
patients with DIC, 61.9% of those patients receiving danaparoid experienced
either disappearance or reduction of symptoms of DIC whereas 62% of those
receiving UFH showed either no change or aggravation of their symptoms.
There
was no significant difference between treatment groups in tolerability or
overall improvement of DIC. CONCLUSIONS: Danaparoid is an effective
anticoagulant agent which has undergone clinical evaluation in a wide range
of
disease indications. Current guidelines support the use of danaparoid in
prophylaxis of DVT following ischaemic stroke, and in patients who develop
HIT.
Danaparoid has shown efficacy in DIC, and for DVT prophylaxis in patients
undergoing hip surgery although further data are required to establish the
role
of danaparoid in these indications. In particular, double-blind trials
comparing
danaparoid with such recommended therapies as the low molecular weight
heparins
will provide more definitive data on the place of danaparoid in the clinical
management of these conditions and ultimately lead to improved patient
outcomes.
Publication Types:
Review
Review, Tutorial
PMID: 12381232 [PubMed - indexed for MEDLINE]
34: Thorac Cardiovasc Surg. 2002 Oct;50(5):315-22.
Evidence-based medicine: lung volume reduction surgery (LVRS).
Koebe HG, Kugler C, Dienemann H.
Schwerpunkt Thoraxchirurgie, Klinikum Kassel, Germany.
Lung volume reduction surgery (LVRS) was developed as a means of surgical
treatment for severe pulmonary emphysema. To date, various studies have been
designed to explain the mechanisms involved in pathophysiological changes
after
treatment, to define criteria for patient selection, to identify the
surgical
technique of choice and to propose appropriate follow-up care. Preliminary
results of follow-up studies (up to five years) have already been published,
indicating improved pulmonary function and quality of life after surgical
treatment. However, the alarming results from the National Emphysema
Treatment
Trial (NETT) Research Group indicated a considerable risk for death in
patients
with homogenous emphysema and low forced expiratory volume in one second (FEV1)
undergoing LVRS. This brief review summarizes the results of currently
published
studies to supply evidence for selection criteria in order to better define
the
subset of patients for which LVRS offers an effective and safe means of
palliation from the symptoms of advanced COPD. Due to acceptable morbidity
and
mortality rates, stapler device wedge excision and closure has become the
standard procedure for removing non-functioning, hyperinflated lung areas in
heterogeneously affected organs. LVRS is carried out in two ways - using
video-assisted thoracoscopic surgery (VATS) as well as
thoracotomy/sternotomy-and performed in unilateral and bilateral procedures.
In
contrast, most clinics have found laser resection of emphysematous
parenchyma to
be unsuccessful. In some patients, LVRS was carried out as an alternative to
lung transplantation, whereas in others, it served as a bridge-to-transplant
procedure. LVRS has proven effective in the reduction of dyspnea, especially
in
patients with recovery options in both the circulatory and pulmonary system.
In
responders, recovery from labored breathing and O(2) dependency and
increased
physical capacity are usually accompanied by improved spirometric data.
These
results are mainly explained by a more regular breathing pattern and an
increase
in the maximum volume of ventilation in the affected lung. In most cases,
functional improvement is maximized during the first six months
postoperatively
and decreases steadily thereafter indicating the need for a systematic
postoperative patient care after surgical treatment. After indicating
at-risk
patients who should not be considered for LVRS, long-term results from the
multicenter NETT research group will hopefully help clarify the impact of
this
treatment on survival of patients further.
Publication Types:
Review
Review, Tutorial
PMID: 12375193 [PubMed - indexed for MEDLINE]
35: Surg Clin North Am. 2002 Jun;82(3):589-609, vii.
Parenchymal sparing operations for bronchogenic carcinoma.
Rendina EA, Venuta F, de Giacomo T, Rossi M, Coloni GF.
Department of Thoracic Surgery, II Clinica Chirurgica, University La
Sapienza,
Rome, Italy. erinoangelo.rendina@tin.it
By the end of the 1950s, the principles of tracheobronchial and pulmonary
artery
(PA) reconstruction had been established, and their successful clinical
application had taken place. It was not until very recently, however, that
these
techniques aroused widespread interest among thoracic surgeons as a means to
achieve complete cancer resection while preserving functioning lung
parenchyma.
At the present time, sleeve resection of the bronchus and/or PA has a
definite
role in the surgical management of lung cancer. Growing interest in this
field
is evidenced by an increasing number of technical variations intended to
adapt
the basic technique to the different anatomical settings. Also pitfalls,
complications, and their prevention and treatment are being extensively
described. Last but not least, functional and oncological long-term results,
comparing favorably with those of more extended resections, are being
reported
by many groups. This demonstrates that sleeve lobectomy is no longer
reserved
only for particularly skillful surgeons. Sleeve lobectomy has achieved its
rightful position among the techniques commonly used in thoracic surgery
after
40 years of improving understanding and alternating enthusiasm and
legitimate
doubts.
Publication Types:
Review
Review, Tutorial
PMID: 12371587 [PubMed - indexed for MEDLINE]
36: Surg Clin North Am. 2002 Jun;82(3):541-59.
Video-assisted thoracic surgery (VATS) resection for lung cancer.
Swanson SJ, Batirel HF.
Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA
02115,
USA. sjswanson@partners.org
VATS is a relatively new technology that has become the standard of care for
basic procedures such as drainage of pleural effusion and blebectomy. VATS
anatomic lung resection is more controversial. Published studies demonstrate
several advantages of VATS over a standard posterolateral thoracotomy. A
minimally invasive approach causes less inflammatory reaction. Acute and
chronic
pain are diminished. As a result, the length of hospitalization is shorter.
Early and late shoulder dysfunction is less and return to work time is
shorter.
Taken together, these factors suggest a better overall outcome using a VATS
approach. From an oncologic standpoint, lymph node dissection can be
accomplished and locoregional recurrence is low. The validity of VATS for
lung
cancer will be determined by long-term data. A phase III national
(intergroup)
protocol is being drafted and will help to answer these questions.
Publication Types:
Review
Review, Tutorial
PMID: 12371584 [PubMed - indexed for MEDLINE]
37: Scand J Infect Dis. 2002;34(8):615-9.
Constrictive pericarditis caused by candida glabrata in an immunocompetent
patient: case report and review of literature.
Neughebauer B, Alvarez V, Harb T, Keefer M.
Division of Infectious Diseases, University of Rochester Medical Center, New
York 14642, USA.
Candida pericarditis is a rare disease described mostly in patients with
recent
cardiothoracic surgery or debilitating chronic diseases and is generally
considered to be associated with high mortality. To our knowledge, we report
the
first case of Candida pericarditis in a healthy host who had not undergone
thoracic surgery and the first documented case and cure of pericarditis
caused
by C. glabrata. The most probable underlying factor in the development of
this
pericarditis was the abdominal surgery the patient underwent to correct a
gastrogastric fistula, without an intraabdominal leak, which developed 10 y
after surgical gastric stapling for weight reduction. The literature on
Candida
pericarditis is reviewed. If Candida pericarditis is diagnosed early and
treated
with a combined medical and surgical approach, the prognosis today is much
more
favorable than that previously reported.
Publication Types:
Case Reports
Review
Review of Reported
Cases
PMID: 12238580 [PubMed - indexed for MEDLINE]
38: Semin Thorac Cardiovasc Surg. 2002 Jul;14(3):281-5.
Management of the subcentimeter pulmonary nodule.
Miller DL.
Emory University School of Medicine and the Section of General Thoracic
Surgery,
Emory University and Emory Clinic, Atlanta, GA 30322, USA.
The most sensitive imaging modality for detection of pulmonary nodules is
computed tomography (CT). Advances in radiologic techniques not only
increase
the number of nodules detected, but also the nodules that are identified are
smaller. With increased use of spiral CT for lung cancer screening, there
will
be more subcentimeter pulmonary nodules (SCPNs) that will require further
diagnostic workup. Radiologic evaluation including repeat observational CT
or CT
contrast enhancement should be performed. Bronchoscopic or needle biopsy of
the
majority of SCPNs is not practical. VATS is possible for SCPNs but should be
performed in a controlled manner to reduce the resection of benign lesions.
An
SCPN management algorithm is necessary to expedite resection of a malignant
lesion and to minimize removal of benign disease. Copyright 2002, Elsevier
Science (USA). All rights reserved.
Publication Types:
Review
Review, Tutorial
PMID: 12232870 [PubMed - indexed for MEDLINE]
39: Br J Neurosurg. 2002 Jun;16(3):211-6.
Learning from Bristol: report of the public inquiry into children's heart
surgery at Bristol Royal Infirmary 1984-1995.
Teasdale GM; Council of the Society of British Neurological Surgeons.
Southern General Hospital, Department of Neurosurgery, Glasgow, UK.
Publication Types:
Review
Review, Tutorial
PMID: 12201391 [PubMed - indexed for MEDLINE]
40: Surg Laparosc Endosc Percutan Tech. 2002 Aug;12(4):295-300.
Thoracoscopy: the preferred method for excision of mediastinal parathyroids.
Kumar A, Kumar S, Aggarwal S, Kumar R, Tandon N.
Department of Surgical Disciplines, All India Institute of Medical Sciences,
Ansari Nagar, New Delhi 110 029, India. arvindreena@hotmail.com
Mediastinal exploration to resect ectopic parathyroid is required in
approximately 2% of all cases of hyperparathyroidism. Traditionally, it has
been
performed through a midsternotomy or thoracotomy. A few reports about
thoracoscopic resection of mediastinal parathyroid were published recently.
We
report here successful video-assisted thoracoscopic resection (VATS) of a
mediastinal parathyroid and present a review of all previously reported
cases. A
42-year-old woman presented with spontaneous fracture of the left femur and
hypercalcemia. She had previously undergone cervical parathyroidectomy for
primary hyperparathyroidism. A computed tomography (CT) scan of the chest
and a
technetium scan showed ectopic mediastinal parathyroid. The patient
underwent
successful thoracoscopic resection of ectopic parathyroid. A total of 26
patients were reviewed, 21 in the English literature and 5 in others. Of the
21
patients reported in the English literature, 16 had primary
hyperparathyroidism
(1 degrees HPT), whereas 5 had secondary hyperparathyroidism (2 degrees
HPT).
All but 3 patients had undergone previous cervical exploration. Ectopic
mediastinal parathyroid was localized preoperatively in all by CT scans of
the
chest and nuclear scans. All 21 patients had successful thoracoscopic
resection.
All but 3 had parathyroid adenoma. Postoperatively, serum calcium (Ca ),
phosphate (PO4 ), and parathormone (PTH) values returned to normal in all
patients. Age and sex of the patient, type of hyperparathyroidism (1 degrees
or
2 degrees ), size of the gland, its location within the anterior
mediastinum,
the approach used to resect it (right or left thoracoscopic), and final
histopathology of the resected gland (adenoma or hyperplasia) had no bearing
on
the success of thoracoscopic resection. The data seem to suggest that
thoracoscopic resection of mediastinal parathyroid is a less-invasive,
effective, and safe procedure. Accurate preoperative anatomic localization
by CT
and nuclear scans of the chest is the key to success.
Publication Types:
Case Reports
Review
Review of Reported
Cases
PMID: 12193831 [PubMed - indexed for MEDLINE]
41: Ann Thorac Surg. 2002 Aug;74(2):615-23.
VATS major pulmonary resection revisited--controversies, techniques, and
results.
Yim AP.
Department of Surgery, The Chinese University of Hong Kong, Prince of Wales
Hospital, Shatin, NT, China. yimap@cuhk.edu.hk
The application of video-assisted thoracoscopic surgery (VATS) in major
pulmonary resections has remained infrequent, despite earlier demonstration
of
its technical feasibility. The early postoperative benefits of this approach
to
patients are now well documented. The intermediate to long-term clinical
results
of VATS major resections for primary cancer are now available and appear
extremely encouraging. There are few, detailed descriptions of this
technique in
the literature. This article reviews the current status of VATS major
resection
with emphasis on its controversies, techniques, and results.
Publication Types:
Review
Review, Tutorial
PMID: 12173869 [PubMed - indexed for MEDLINE]
42: Surg Endosc. 2002 Jun;16(6):881-92. Epub 2002 Feb 28.
State of the art in thoracospic surgery: a personal experience of 2000
videothoracoscopic procedures and an overview of the literature.
Roviaro GC, Varoli F, Vergani C, Maciocco M.
Department of Surgery, S. Giuseppe Hospital Fbf, A.Fa. R., University of
Milan,
12 via San Vittore, 20123 Milan, Italy. gian.roviaro@unimi.it
BACKGROUND: Herein we compare our personal experience with a series of >
2000
videothoracoscopic procedures with those reported in the literature to
identify
the procedures now accepted as the gold standard, those still regarded as
investigational, and those considered unacceptable. METHODS: Between June
1991
and December 2000, we performed 2068 videothoracoscopic procedures, including
lung cancer staging (n = 910), wedge resections (n = 261), lobectomies (n =
221), pneumonectomies (n = 6), the diagnosis and treatment of pleural
diseases
(n = 200), the treatment of pneumothorax (n = 170), giant bullae (n = 57),
lung
volume reduction surgery (LVRS) for emphysema (n = 41), the diagnosis and
treatment of mediastinal diseases (n = 133), the treatment of esophageal
diseases (n = 39), and 30 other miscellaneous procedures. RESULTS: A review
of
the literature indicates that videothoracoscopy is usually considered the
preferred approach for the treatment of spontaneous pneumothorax, the
diagnosis
of indeterminate pleural effusions, the treatment of malignant pleural
effusions, sympathectomy, and the diagnosis and treatment of benign esophageal
or mediastinal diseases. The videoendoscopic approach to LVRS for emphysema
is
still under evaluation. Videothoracoscopic wedge resections for the
diagnosis of
indeterminate nodules and the treatment of primary lung cancer, metastases,
and
other malignancies are still controversial due to oncologic concerns.
Videoendoscopic major pulmonary resections are usually considered
investigational or even unacceptable due to oncologic concerns, technical
difficulties, and the risk of complications. CONCLUSIONS: Although we
generally
agree with the foregoing recommendations, we consider videoendoscopy the
best
approach for LVRS and particularly useful for the staging of lung cancer,
where
we always perform it as the first step of the operation. We widely perform
videoendoscopic major pulmonary resections, but we believe that these
procedures
should only be used in strictly selected cases and at specialized centers.
Publication Types:
Review
Review Literature
PMID: 12163949 [PubMed - indexed for MEDLINE]
43: Middle East J Anesthesiol. 2002 Jun;16(5):485-91.
Anesthesia for transthoracic endoscopic sympathectomy--an overview.
el-Dawlatly AA.
Department of Anesthesia & ICU, College of Medicine, King Saud
University Riyadh
11461, P.O. Box 2925. dawlatly@ksu.edu.sa
Publication Types:
Review
Review, Tutorial
PMID: 12138511 [PubMed - indexed for MEDLINE]
44: Chest Surg Clin N Am. 2002 May;12(2):251-63.
Postthoracotomy pain management.
Savage C, McQuitty C, Wang D, Zwischenberger JB.
Division of Cardiothoracic Surgery, University of Texas Medical Branch, 301
University Blvd., Galveston, TX 77555-0528, USA. claresavage@yahoo.com
The following techniques appear efficacious in controlling postthoracotomy
pain
and reducing the amount of systemic opioids consumed: continuous intercostal
blockade, paravertebral blockade, and epidural opioids and/or anesthetics.
The
combination of thoracic epidural opioid and local anesthetic is very
effective
at relieving postthoracotomy pain, however, considerable experience is
required
for insertion of the thoracic epidural catheter and postoperative
respiratory
monitoring. Intercostal and paravertebral catheters can be inserted
intraoperatively under direct visualization, to reduce complications of
insertion. One-time intraoperative intercostal blockade may effectively
reduce
postoperative pain in the first day, but is not a practical long-term method
for
postthoracotomy pain. The effectiveness of interpleural analgesia, even with
proper technique, appears inferior to epidural and other regional
techniques. We
have incorporated the principles outlined in this review into our general
thoracic surgery protocol, as detailed in Fig. 1. Every patient is assessed
preoperatively for epidural catheter placement. Contraindications include
low
platelet count (< 100,000), abnormal coagulation profile, medicinal
anticoagulation (aspirin and nonsteroidal anti-inflammatories are not
contraindications), bony spinal abnormalities, or neurological disorders.
The
T5/6 interspace is our preferred level, but T10 can work well with an
increased
dose of bupivacaine. Upon completion of the muscle sparing, minimal-access
thoracotomy, we close the wound and perform a percutaneous intercostal nerve
block (two ribs above and three below the incision). We then use
patient-controlled epidural analgesia, with a basal infusion of bupivacaine
and
hydromorphone. To supplement inadequate or nonfunctioning epidurals,
intravenous
patient-controlled opioids are added. When choosing an approach to
postthoracotomy pain management, the thoracic surgeon and anesthesiologist
must
consider the following: (1) the physician's experience, familiarity and
personal
complication rate with specific techniques; (2) the desired extent of local
and
systemic pain control; (3) the presence of contraindications to specific
analgesic techniques and medications; and (4) availability of appropriate
facilities for patient assessment and monitoring postthoracotomy.
Refinements in
surgical technique including limited or muscle-sparing thoracotomy,
video-assisted thoracoscopic surgery (VATS) and robotic surgery may lessen
the
magnitude of postthoracotomy pain. We encourage all thoracic surgeons to be
knowledgeable of available techniques and maintain a protocol to generate a
database for periodic assessment of safety and efficacy.
Publication Types:
Review
Review, Tutorial
PMID: 12122825 [PubMed - indexed for MEDLINE]
45: J Am Coll Surg. 2002 Jul;195(1):55-71.
What's new in general thoracic surgery.
Miller JL Jr.
Department of Surgery, Emory University School of Medicine, Atlanta, GA,
USA.
Publication Types:
Review
Review, Tutorial
PMID: 12113546 [PubMed - indexed for MEDLINE]
46: Cochrane Database Syst Rev. 2002;(2):CD001956.
Surgical versus non-surgical management of pleural empyema.
Coote N.
Ward D1 Hammersmith Hospital, Du Cane Road, London, UK, W12 0HS.
NickyCoote@doctors.org.uk
BACKGROUND: Pleural empyema is a collection of pus between the lungs and the
chest wall. Approximately 50% of cases complicate pneumonia. There are a
variety
of treatment options ranging from intravenous antibiotics alone to open
thoracotomy and debridement, depending in part on the stage of the empyema
and
the severity. The condition changes with time, becoming loculated and more
difficult to drain. There is much debate about the most appropriate therapy
particularly with the advent of new treatments such as fibrinolytic enzymes
(e.g. streptokinase, urokinase) and video-assisted thoracoscopic surgery
(VATS).
OBJECTIVES: To determine which is more effective for the management of
empyema:
surgical (e.g. thoracoscopy, thoracotomy) or non-surgical techniques (e.g.
thoracocentesis, chest tube drainage) and to establish whether there is an
optimum time for intervention. SEARCH STRATEGY: The Cochrane Controlled
Trials
Register and DARE database were searched in addition to the Cochrane Acute
Respiratory Infections Group's own register of trials. A specialised topic
search with no language restrictions was used to search MEDLINE and EMBASE
using
Silverplatter. Bibliographies and the reference lists of identified studies
and
review articles were handsearched. Personal communication with authors and
experts in the field is ongoing. SELECTION CRITERIA: Randomised controlled
trials (RCTs) of surgical techniques versus non-surgical approaches for
treatment of pus in the pleural cavity in children and adults but not
neonates.
Studies of empyema associated with tuberculosis or malignancy were excluded.
DATA COLLECTION AND ANALYSIS: Trial quality was assessed using Jadad
criteria as
recommended by the ARI group (Jadad 1996). The primary outcomes were death
or
resolution of the empyema. Secondary outcomes addressed length of time chest
tubes were required, pain, hospital stay and any complications. MAIN
RESULTS:
Only one small randomised study was identified which met the inclusion
criteria.
It was conducted in a university thoracic surgery department. There were
some
methodological quality considerations which cast some doubt on validity (
patient selection, unclear allocation concealment and outcome assessor
blinding)
and it scored 'B' overall (Jadad score 3). The main results of the study
were
that when compared with chest tube drainage combined with streptokinase, the
video-assisted thoracoscopic surgery (VATS) group had a significantly higher
primary treatment success and spent less time in hospital. Each group
suffered
one mortality. REVIEWER'S CONCLUSIONS: It would appear that for large,
loculated
pleural empyemas VATS is superior to chest tube drainage with streptokinase
in
terms of duration of chest tubes and hospital stay. However there are
questions
about validity and the study is also too small to draw conclusions. There
are
risks of complications (associated with all treatments) which may not
apparent
with small numbers. VATS is performed under general anaesthetic and one lung
ventilation. Fibrinolytics are also associated with side effects. Further
larger
multicentre studies need to be conducted.
Publication Types:
Review
Review, Academic
PMID: 12076430 [PubMed - indexed for MEDLINE]
47: Scand J Surg. 2002;91(1):67-71.
Cavitary endoscopy in trauma: 2001.
Smith RS.
Department of Surgery, University of Kansas, School of Medicine-Wichita,
67214,
USA. rsmith3@kumc.edu
Laparoscopy and thoracoscopy have been used in the evaluation of injured
patients for over 30 years. Despite this long history, indications for use
of
these techniques remains controversial. The widespread availability of
videoscopic equipment which followed the introduction of laparoscopic
cholecystectomy increased interest and utilization of minimally invasive
techniques in evaluation of trauma patients. Laparoscopy has been most
beneficial in the evaluation of hemodynamically stable victims of stabbings
and
gunshots. This technique has primarily been used to detect peritoneal
penetration in tangential wounds of the abdominal wall and for evaluation of
the
diaphragm in patients with thoracoabdominal wounds. Laparoscopic evaluation
in
blunt trauma patients is of unproven utility, but has been used in the
assessment of patients with documented solid organ injury and in the
evaluation
of patients with suspected hollow viscus injury. Small subsets of patients
are
candidates for therapeutic laparoscopic interventions, i.e., suture repair
of
diaphragmatic lacerations. Thoracoscopy or videoassisted thoracic surgery
(VATS)
is useful for evaluation of the diaphragm, early evacuation of clotted
hemothorax, and assessment of ongoing bleeding.
Publication Types:
Review
Review, Tutorial
PMID: 12075839 [PubMed - indexed for MEDLINE]
48: Curr Opin Pulm Med. 2002 Jul;8(4):323-6.
Thoracoscopy in management of postpneumonic pleural infections.
Waller DA.
Consultant Thoracic Surgeon, Glenfield Hospital, Leicester, United Kingdom.
debra.grew@uhl-tr.uhl.uk
With expanding overall experience of video-assisted thoracic surgery in the
last
decade, its use in postpneumonic pleural infection is increasing, as shown
by a
larger number of publications advocating its efficacy. The main areas of
study
in the use of video-assisted thoracic surgery in this condition are (1) as
an
alternative to traditional open thoracotomy and (2) as an additional
treatment
option in the management of earlier-stage disease. The benefits of the
minimally
invasive approach are particularly attractive in the treatment of pediatric
pleural infection. Controversy surrounds its comparative benefits over
intrapleural fibrinolysis in early exudative or fibrinopurulent pleural
empyema
and its usefulness in the treatment of chronic pleural empyema.
Publication Types:
Review
Review, Tutorial
PMID: 12055397 [PubMed - indexed for MEDLINE]
49: Curr Opin Pulm Med. 2002 Jul;8(4):281-6.
Role of video-assisted thoracoscopic surgery and classic thoracotomy in lung
cancer management.
Moffatt SD, Mitchell JD, Whyte RI.
Department of Cardiothoracic Surgery, Stanford University, Stanford,
California
94305-5407, USA.
Lung cancer is the leading cause of cancer-related death worldwide. For
patients
diagnosed with early-stage lung cancer, complete surgical resection remains
the
best hope for cure. Limited resections are avoided when possible because of
higher recurrence rates and potentially worse long-term survival.
Traditionally,
a posterolateral thoracotomy has been used to perform anatomic lung
resections
and mediastinal lymph node dissection for complete staging. More recently,
the
use of video-assisted thoracoscopic surgery has been introduced for the
treatment of stage I lung cancers. Although thought minimally invasive and
thus
perceived as resulting in less postoperative pain and faster recovery, its
acceptance has varied worldwide. Questions about training, cost containment,
and
oncologic principles prevail. In essence, the absolute indications and
limitations of video-assisted thoracoscopic surgery for patients with lung
cancer have yet to be defined.
Publication Types:
Review
Review, Tutorial
PMID: 12055390 [PubMed - indexed for MEDLINE]
50: J Am Coll Surg. 2002 May;194(5):617-35.
What's new in cardiac surgery.
Merrill WH.
Department of Cardiothoracic Surgery, Vanderbilt Clinic, Nashville, TN
37232-5734, USA.
Publication Types:
Review
Review, Tutorial
PMID: 12022603 [PubMed - indexed for MEDLINE]
51: Jpn J Thorac Cardiovasc Surg. 2002 Apr;50(4):168-72.
Thoracoscopic approach for congenital bronchoesophageal fistula in an adult.
Hirata T, Koizumi K, Haraguchi S, Hirai K, Mikami I, Tanaka S.
Department of Surgery II, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku,
Tokyo
113-8602, Japan.
We present a case of a congenital bronchoesophageal fistula in an adult male
who
underwent video-assisted thoracic surgery for a resection of the fistula.
The
patient had not suffered from any serious respiratory infection since the
adolescence. However, at 49 years old, the patient experienced persistent
cough
and back pain. An abnormal shadow in the right lower lobe was observed on a
chest X-ray. Chest computed tomography scanning indicated bronchiectasia in
the
lower superior segment and an abnormal air duct in the posterior
mediastinum.
Esophagography revealed a 4-cm-long and 1-cm-diameter fistula between the
midesophagus and the right lower lobe. Esophagoscopy and bronchoscopy
revealed
the orifice of the fistula. Three-dimensional computed tomography scanning
demonstrated that there was no abnormal artery supplying blood to the
affected
lung. He underwent video-assisted thoracic surgery, and was uneventfully
discharged. Thoracoscopy offered excellent anatomical visualization of the
fistula and safe surgical resection.
Publication Types:
Case Reports
Review
Review of Reported
Cases
PMID: 11993199 [PubMed - indexed for MEDLINE]
52: Curr Opin Pulm Med. 2002 May;8(3):218-23.
Pulmonary hydatid and other lung parasitic infections.
Kilani T, El Hammami S.
Department of Thoracic and Cardiovascular Surgery, Abderrahmane MAMI
Hospital,
Ariana, Tunisia. tarek.kilani@rns.tn
The lung may be infested by a great number of parasites. Hydatidosis is the
most
frequent parasitic lung disease. Diagnosis of lung hydatidosis is usually
easy
on chest radiography, ultrasonography, and CT scan, and immunodiagnosis may
help
in dubious cases. Surgery is necessary in most cases, but it must be
conservative. Complex forms, such as disseminated disease and secondary lung
hydatidosis (metastatic or bronchogenic) are difficult to treat and may be
considered malignant. Medical treatment may be helpful in complex forms, in
poor
surgical risk patients, and in cases of preoperative spillage of hydatic
fluid.
Prevention programs are necessary in endemic areas, and research must be
directed toward vaccination against the parasite. Other parasitic diseases
are
reported less frequently in the literature, and the majority of published
articles are either case reports or only report a small number of cases.
Clinical presentation is variable according to the great variety of
parasites
that may involve the lungs.
Publication Types:
Review
Review, Tutorial
PMID: 11981312 [PubMed - indexed for MEDLINE]
53: Can Respir J. 2002 Mar-Apr;9(2):122-7.
Video-assisted thoracic surgery in spontaneous pneumothorax.
Ng CS, Wan S, Lee TW, Wan IY, Arifi AA, Yim AP.
The Chinese University of Hong Kong, Prince of Wales Hospital, Sha Tin NT,
Hong
Kong.
The proven safety and efficacy of minimal access video-assisted thoracic
surgery
has changed the way that spontaneous pneumothorax is managed. This review
presents some of the experiences of the decade, discusses the controversies
and
reviews the current video-assisted thoracic surgical management of
spontaneous
pneumothorax.
Publication Types:
Review
Review, Tutorial
PMID: 11972165 [PubMed - indexed for MEDLINE]
54: J Gen Intern Med. 2002 Mar;17(3):193-202.
Optimal strategy for the first episode of primary spontaneous pneumothorax
in
young men. A decision analysis.
Morimoto T, Fukui T, Koyama H, Noguchi Y, Shimbo T.
Department of Clinical Epidemiology, Kyoto University Graduate School of
Medicine, Japan.
OBJECTIVE: Primary spontaneous pneumothorax (PSP) is not uncommon in young
men
and is associated with frequent recurrence. The frequent recurrence after
conservative treatment and resultant anxiety for recurrence are sources of
disability. We explored which procedure is more appropriate as the initial
therapy in terms of quality-adjusted life expectancy (QALE). DESIGN:
Decision
analysis using a Markov model. DATA SOURCES: Structured literature review
for
clinical probability. Utility derived from patients and medical staff using
time
trade-off method. SETTING: Hypothetical cohort. PATIENTS: Twenty-year-old
men
with a first episode of PSP for which simple aspiration was ineffective.
INTERVENTIONS: One of the following treatment options: 1) thoracoscopic
surgery,
2) pleural drainage followed by thoracoscopic surgery for recurrence, 3)
pleural
drainage followed by thoracoscopic surgery for the second recurrence, 4)
pleurodesis followed by thoracoscopic surgery for recurrence, 5) pleurodesis
followed by thoracoscopic surgery for the second recurrence, 6) pleural
drainage
followed by pleurodesis for the first recurrence and thoracoscopic surgery
for
the second recurrence. MEASUREMENTS AND MAIN RESULTS: During the 1-year
period
after one of the initial treatments, the QALE was 9.49 months for
thoracoscopic
surgery, 9.47 for pleurodesis, and 7.80-7.99 for pleural drainage. The QALE
for
thoracoscopic surgery was the longest among the 6 strategies during the
period
from 5 to 24 months. None of the variables in sensitivity analyses altered
the
main results except for thoracoscopic surgical death rate. When it exceeds
0.3%,
pleurodesis becomes the preferred strategy. CONCLUSION: On the basis of the
current best available data and patients' preference, thoracoscopic surgery
can
be considered the treatment of choice for the first episode of PSP.
Publication Types:
Review
Review, Academic
PMID: 11929505 [PubMed - indexed for MEDLINE]
55: ANZ J Surg. 2002 Jan;72(1):40-5.
Comment in:
ANZ J Surg. 2002
Jan;72(1):1.
Paradigm shift in surgical approaches to thymectomy.
Yim AP.
Chinese University of Hong Kong, Department of Surgery, Prince of Wales
Hospital, Shatin, Hong Kong. yimap@cuhk.edu.hk
BACKGROUND: Thymectomy is an established therapy in the management of
myasthenia
gravis (MG) used in conjunction with medical treatment. The optimal surgical
approach to thymectomy, however, has remained controversial. METHOD: The
present
review discusses the author's experiences of and the literature regarding
the
management of MG using the video-assisted thoracic surgery (VATS) approach.
RESULTS: This approach was shown to be technically safe in experienced hands
and
associated with less postoperative pain, better preservation of lung
function in
the early postoperative period and better cosmetic results than alternative
techniques. The intermediate term results of VATS are comparable to those of
more radical approaches. It is hoped that this patient-friendly approach
will
lead to greater support by patients and their neurologists, for earlier
surgery.
CONCLUSION: VATS is an attractive, alternative approach to thymectomy.
Publication Types:
Review
Review, Tutorial
PMID: 11906423 [PubMed - indexed for MEDLINE]
56: Orthop Nurs. 2000 Nov-Dec;19(6):15-22.
Thoracoscopic spine surgery: current indications and techniques.
Kuklo TR, Lenke LG.
Washington University School of Medicine, St. Louis, Missouri, USA.
The first report of thoracoscopic surgery was in 1910, after Jacobaeus used
thoracoscopy to lyse tuberculous lung adhesions. However, it was not until
the
end of the century that Lewis (1991) recognized the value of thoracoscopic
surgery, and Mack (1993) reported the application of video-assisted thoracic
surgery (VATS) for spine surgery. VATS is still in its infancy and the
application of this technology for spine surgery continues to rapidly
expand.
The current indications for thoracoscopic spine surgery include tissue
biopsies,
thoracic paravertebral abscess drainage and debridement, thoracic disc
herniation excisions, anterior spinal release and/or fusion for spinal
deformity, stabilization and fusion of thoracic and thoracolumbar fractures,
corpectomy for vertebral tumors, and the placement of anterior spinal
instrumentation with fusion. This article reviews these current indications
for
VATS--the technique and subsequent nursing implications.
Publication Types:
Review
Review, Tutorial
PMID: 11899304 [PubMed - indexed for MEDLINE]
57: Anesthesiol Clin North America. 2002 Mar;20(1):153-80.
Pediatric thoracic anesthesia.
Hammer GB.
Department of Anesthesia, Stanford University Medical Center, Palo Alto,
California, USA.
The anesthesiologist caring for infants and children undergoing thoracic
surgery
faces many challenges. An understanding of the primary underlying lesion as
well
as associated anomalies that may impact perioperative management is
paramount. A
working knowledge of respiratory physiology and anatomy in infants and
children
is required for the planning and execution of appropriate intraoperative
care.
Familiarity with a variety of techniques for SLV suited to the patient's
size
will allow maximal surgical exposure while minimizing trauma to the lungs
and
airways. Finally, use of regional anesthetic techniques, including epidural
anesthesia and analgesia, facilitates optimal postoperative pain control and
pulmonary function.
Publication Types:
Review
Review, Academic
PMID: 11892503 [PubMed - indexed for MEDLINE]
58: Crit Care Nurs Q. 2000 May;23(1):54-65.
Minimally invasive coronary artery bypass surgery.
Cucinelli C.
Allegheny General Hospital, Pittsburgh, Pennsylvania, USA.
Advances in videoscopic instrumentation and expanding experience with the
performance of coronary artery bypass surgery without cardiopulmonary
circulatory support is changing the surgical approach to many patients
requiring
coronary arterial revascularization. We describe the present status of
minimally
invasive coronary artery bypass surgery being used today.
Publication Types:
Review
Review, Tutorial
PMID: 11852958 [PubMed - indexed for MEDLINE]
59: Surg Today. 2001;31(12):1074-8.
Periosteal chondroma of the rib: report of two cases.
Inoue S, Fujino S, Kontani K, Sawai S, Tezuka N, Hanaoka J.
Department of Thoracic Surgery, Shiga National Hospital, Youkaichi, Japan.
We report two cases of periosteal chondroma of the rib, an extremely rare
entity. The first case involved a 5-year-old boy who was admitted with pain
and
swelling around his left fifth rib. Surgery was performed in May 1999, and
an 8
x 6 x 5 mm tumor was resected with the fifth rib. The second case involved a
39-year-old man with a 2-month history of cough who was referred to our
department after a coin lesion had been detected on a chest roentgenogram.
Physical examination on admission did not reveal any pain or tenderness. The
rib
tumor was resected along with the fourth rib by video-assisted thoracoscopic
surgery and minithoracotomy in February 2000. The tumor was well encapsulated
and consisted of an elastic hard mass measuring 22 x 15 x 13 mm. Both
patients
had an uneventful postoperative course and have remained well with no
evidence
of recurrence. Our review of the literature revealed only six previously
documented cases of periosteal chondroma of the rib.
Publication Types:
Case Reports
Review
Review of Reported
Cases
PMID: 11827186 [PubMed - indexed for MEDLINE]
60: Ann Thorac Surg. 2001 Dec;72(6):2155-68.
Comment in:
Ann Thorac Surg.
2001 Dec;72(6):1845-8.
Ann Thorac Surg.
2002 Jul;74(1):294; author reply 294.
Cardiac surgery report cards: comprehensive review and statistical critique.
Shahian DM, Normand SL, Torchiana DF, Lewis SM, Pastore JO, Kuntz RE, Dreyer
PI.
Department of Thoracic and Cardiovascular Surgery, Lahey Clinic, Burlington,
Massachusetts 01805, USA. david.m.shahian@lahey.org
Public report cards and confidential, collaborative peer education represent
distinctly different approaches to cardiac surgery quality assessment and
improvement. This review discusses the controversies regarding their
methodology
and relative effectiveness. Report cards have been the more commonly used
approach, typically as a result of state legislation. They are based on the
presumption that publication of outcomes effectively motivates providers,
and
that market forces will reward higher quality. Numerous studies have
challenged
the validity of these hypotheses. Furthermore, although states with report
cards
have reported significant decreases in risk-adjusted mortality, it is
unclear
whether this improvement resulted from public disclosure or, rather, from
the
development of internal quality programs by hospitals. An additional
confounding
factor is the nationwide decline in heart surgery mortality, including
states
without quality monitoring. Finally, report cards may engender negative
behaviors such as high-risk case avoidance and "gaming" of the
reporting system,
especially if individual surgeon results are published. The alternative
approach, continuous quality improvement, may provide an opportunity to
enhance
performance and reduce interprovider variability while avoiding the
unintended
negative consequences of report cards. This collaborative method, which uses
exchange visits between programs and determination of best practice, has
been
highly effective in northern New England and in the Veterans Affairs
Administration. However, despite their potential advantages, quality
programs
based solely on confidential continuous quality improvement do not address
the
issue of public accountability. For this reason, some states may continue to
mandate report cards. In such instances, it is imperative that appropriate
statistical techniques and report formats are used, and that professional
organizations simultaneously implement continuous quality improvement
programs.
The statistical methodology underlying current report cards is flawed, and
does
not justify the degree of accuracy presented to the public. All existing
risk-adjustment methods have substantial inherent imprecision, and this is
compounded when the results of such patient-level models are aggregated and
used
inappropriately to assess provider performance. Specific problems include
sample
size differences, clustering of observations, multiple comparisons, and
failure
to account for the random component of interprovider variability. We
advocate
the use of hierarchical or multilevel statistical models to address these
concerns, as well as report formats that emphasize the statistical
uncertainty
of the results.
Publication Types:
Review
Review Literature
PMID: 11789828 [PubMed - indexed for MEDLINE]
61: Chest Surg Clin N Am. 2001 Nov;11(4):701-21, vii-viii.
Bronchoscopic diagnosis and staging of lung cancer.
Savage C, Morrison RJ, Zwischenberger JB.
Department of Surgery, University of Texas Southwestern, Dallas, Texas, USA.
In the past 2 decades, flexible bronchoscopy (FB) with forceps biopsy and
transbronchial needle aspiration (TBNA); computed tomography (CT)-guided,
transthoracic fine-needle aspiration (FNA); and endoscopic ultrasonography
(EUS)
have revolutionized lung cancer diagnosis and staging by facilitating
precise
biopsy of lung lesions and virtually all mediastinal lymph-node stations. In
this article the authors present an algorithm for the diagnosis and staging
of
lung cancer that addresses sampling of suspicious lesions and lymph nodes by
means of FB, CT, ultrasonography, fluoroscopy, and EUS, emphasizing
tissue-based
diagnosis and staging by means of image-guided technology with the highest
diagnostic yield. They discuss the approach to the diagnosis and staging of
lung
cancer by techniques guided by FB, with particular attention to the increasing
role of TBNA in this field. Additionally, the authors propose a rating scale
based on the degree of invasiveness and diagnostic yield, comparing FB with
other diagnostic techniques.
Publication Types:
Review
Review, Tutorial
PMID: 11780291 [PubMed - indexed for MEDLINE]
62: AACN Clin Issues. 2001 May;12(2):305-23.
Postoperative nosocomial pneumonia: nurse-sensitive interventions.
Brooks JA.
Indiana University Medical Center, Pulmonary, Critical Care and Occupational
Medicine, 550 N. University Boulevard, UH5450, Indianapolis, IN 46202-5250,
USA.
jbrooksb@iupui.edu
Nosocomial pneumonia (NP) is well documented as the second most common
nosocomial infection. It is now more common in surgical patients than
surgical-site or wound infection. Healthcare implications of NP include not
only
increased patient morbidity and mortality, but also increased use of
healthcare
resources. The advanced practice nurse plays an integral role in the
prevention
and minimization of NP across healthcare settings. This article focuses on
postoperative NP after abdominal, cardiac, or thoracic surgery in the
non-mechanically ventilated patient and discusses the diagnostic assessment,
risk factors, and potential nurse-sensitive interventions to prevent or
minimize
this complication. Ideas for potential nursing research related to these
risk
factors are described.
Publication Types:
Review
Review, Tutorial
PMID: 11759557 [PubMed - indexed for MEDLINE]
63: Lung Cancer. 2001 Dec;34 Suppl 3:S3-5.
Invasive staging of lung cancer by mediastinoscopy and video-assisted
thoracoscopy.
Hoffmann H.
Department of Thoracic Surgery, Chirurgische Abteilung,
Thoraxklinik-Heidelberg
gGmbH, Amalienstrasse 5, D-69126, Heidelberg, Germany. hoffmann@medpages.de
Accurate evaluation of the outcomes of clinical trials using preoperative
chemotherapy in a multimodality treatment protocol may require invasive
pretreatment staging for pathologic confirmation of the clinical TNM.
Mediastinoscopy and videothoracoscopy complement each other to provide
appropriate staging of lung cancer. Invasive staging utilizing both methods
may
accurately determine the presence or absence of N2 and N3 disease, and
identify
T3 or T4 or thoracic M1 disease.
Publication Types:
Review
Review, Tutorial
PMID: 11740986 [PubMed - indexed for MEDLINE]
64: Lung Cancer. 2001 Dec;34 Suppl 2:S133-6.
Surgery for non-small cell lung cancer--new trends.
Waller DA.
Department of Thoracic Surgery, Glenfield Hospital, Groby Road, LE3 9QP,
Leicester, UK. debra.grew@uhl-tr.nhs.uk
New trends in lung cancer surgery focus on new approaches to the management
of
the primary tumour, combined modality approaches to both local and distant
control of the tumour, new approaches to ensure resectability by staging and
techniques to expand the limits of operability. With new screening methods
for
NSCLC there is a trend toward sublobar, segmental resections of smaller
tumours
including an expanding use of video assisted thoracoscopy. Improvements in
surgical and anaesthetic procedures have stimulated a renewed interest in
the
resection of locally advanced tumours. The understanding that local control
alone may not give the best chance of long term survival has stimulated new
trends in the use of neoadjuvant and adjuvant chemotherapy. There is a trend
towards more detailed preoperative and intraoperative nodal staging in
NSCLC,
including video assisted techniques, and the identification of sentinel
lymph
node involvement to direct lymph node dissection. Increased understanding of
the
physiological benefits of surgery in emphysema have resulted in a
re-evaluation
of the selection of patients for lung cancer surgery. This together with a
greater application of bronchoplastic and angioplastic techniques is leading
to
greater resection rates.
Publication Types:
Review
Review, Tutorial
PMID: 11720754 [PubMed - indexed for MEDLINE]
65: Heart Dis. 1999 Jul-Aug;1(3):138-48.
Review of the development, validation, and application of predictive
instruments
in interventional cardiology.
Goldberg Arnold RJ, Akhras KS, Chen C, Chen S, Pettit KG, Kaniecki DJ.
Pharmacon International, Inc., New York, New York 10118-0110, USA.
Within the last few years, risk assessment has become an integral part of
clinical practice, particularly for thoracic surgery and interventional
procedures. Risk assessment statistical models are being used in medical
decision making, quality improvement tools, and as aids to patient
counseling.
This literature review was conducted to evaluate the types of predictive
models
and outcomes measures that have been examined, and methods used in
development,
validation, and application of these models. A Medline search performed to
identify articles (limited to human studies) published in English from 1980
to
1999 resulted in 89 articles, of which 71 were evaluable. Populations
studied
for model development included patients undergoing coronary artery bypass
graft
(CABG), percutaneous transluminal coronary revascularization (PTCR), cardiac
catheterization, or stenting procedures and patients with angina or stroke.
The
models were equally developed from a single center versus multicenter and
from
retrospective databases versus prospective studies. In terms of model
perspectives, only three of the models measured cost or cost-effectiveness
as
the outcome; the remainder considered only clinical outcomes. The most
commonly
reported types of predictive models were developed using logistic regression
and
Bayesian techniques, followed by neural networks, rule-based artificial
intelligence, simultaneous equation system, and multiple linear regression.
Factors to consider when developing or evaluating a predictive model include
uniformity of definitions of outcomes, uniformity of definitions of
variables,
completeness of data, number and frequency of variables, timeliness and
source
of data, development population characteristics, development and testing
(validation) cohorts, and calibration and discrimination. Application of
these
models to an individual patient can spur quality improvement efforts that
can
lead to dramatic, system-wide improvements in outcomes.
Publication Types:
Review
Review Literature
PMID: 11720617 [PubMed - indexed for MEDLINE]
66: Anesthesiology. 2001 Sep;95(3):771-80.
Comment in:
Anesthesiology.
2002 Aug;97(2):521; author reply 521-2.
Thoracic paravertebral block.
Karmakar MK.
Department of Anesthesia & Intensive Care, The Chinese University of
Hong Kong,
Prince of Wales Hospital, Shatin, New Territories. karmakar@cuhk.edu.hk
Publication Types:
Review
Review, Tutorial
PMID: 11575553 [PubMed - indexed for MEDLINE]
67: Anesthesiol Clin North America. 2001 Sep;19(3):611-25.
Post-thoracotomy analgesia.
Conacher ID.
Department of Thoracic Anaesthesia, Freeman Hospital, Newcastle upon Tyne
Hospitals NHS Trust, United Kingdom.
Pain relief has come a long way in 20 years. Many aspects of the relief of
pain
of thoracic surgery must be rationalized and modernized to meet the demands
placed on services and subject to new dynamics. To place the present state
of
practice and knowledge in the context of an anticipation that such attitudes
will impact on and, ultimately, drive services for relief of pain, the key
issues of safety, defining and measuring quality, and giving value for money
must be addressed. Rationing is the impetus; the exercise to be conducted by
those interested in the field of thoracic pain relief is to recognize that
not
all patients can have or require five-star services and gold standard
techniques
but are entitled to an equally high quality and measure of pain relief.
Newer
drugs, such as clonidine, ropivacaine, and modified local anesthetics, are
on
the horizon; old drugs, such as ketamine, are being revisited. Their place
in
the field will become apparent only if the ways that outcome measures are
presented are more uniform and standard. Disaggregation analysis, pain
profiling, a revisitiation of respiratory restoration factor, and
optimization
modeling are suggested ways forward to meet the clinical and
organizationally
holistic population forces being generated on the cusp of the third
millennium.
Increasingly, we live in a world defined by guidelines and protocols. The
challenge is ensuring that these measure up to the watchwords--effective,
safe,
affordable.
Publication Types:
Review
Review, Academic
PMID: 11571909 [PubMed - indexed for MEDLINE]
68: Anesthesiol Clin North America. 2001 Sep;19(3):581-90, vii.
Lessons from lung transplantation for everyday thoracic anesthesia.
Myles PS.
Department of Anaesthesia and Pain Management, Alfred Hospital, Australia.
p.myles@alfred.org.au
Patients with end-stage lung disease are at significant risk of hypoxia and
dynamic hyperinflation during mechanical ventilation, particularly during
one-lung ventilation. This article describes aspects of care such as
patients,
including acceptance of permissive hypercapnia, adjustment of ventilator
settings, and methods to optimize recovery from anesthesia.
Publication Types:
Review
Review, Multicase
PMID: 11571907 [PubMed - indexed for MEDLINE]
69: Anesthesiol Clin North America. 2001 Sep;19(3):455-74.
Lung isolation techniques.
Campos JH.
Department of Anesthesia, College of Medicine, University of Iowa Hospitals
and
Clinics, Iowa City, Iowa, USA. javier-campos@uiowa.edu
Left-sided double-lumen endotracheal tubes should be the tube of choice for
most
cases in which lung isolation is required. A right-sided double-lumen
endotracheal tube can be used effectively when a contraindication to placing
a
left-sided double-lumen endotracheal tube exists. The method of choice to
select
left-sided double-lumen endotracheal tubes is based on chest radiograph or
CT
scan measurements of the trachea or bronchus. Based on clinical reports,
Univents or WEB blockers may be a better choice for patients with difficult
airways who require one-lung ventilation or for when a selective lobar
blockade
is needed. For all selective intubation, the method of choice for proper
tube
placement and bronchial blockade is fiberoptic bronchoscopy with the patient
in
a supine position at first or in a lateral decubitus position later, or if a
malposition occurs.
Publication Types:
Review
Review, Tutorial
PMID: 11571902 [PubMed - indexed for MEDLINE]
70: Anesthesiol Clin North America. 2001 Sep;19(3):435-53, v.
Pathophysiology of one-lung ventilation.
Szegedi LL.
Department of Anesthesiology, Division of Thoracic and Cardiovascular
Anesthesia, Erasme University Hospital, Brussels, Belgium.
llszegedi@village.uunet.be
The management of some problematic patients having thoracic surgery is among
the
most difficult challenges for the anesthesiologist. Increasingly complex
operations are performed on seriously compromised patients because of the
development of new surgical techniques and the anesthesiologists' awareness
of
surgical needs and requirements to provide a satisfactory and safe surgical
field. In order to facilitate thoracic surgery, the single most important
and
valuable anesthetic technique used actually is one-lung ventilation. This
article reviews the complex pathopysiology of one-lung ventilation.
Publication Types:
Review
Review, Academic
PMID: 11571901 [PubMed - indexed for MEDLINE]
71: Am J Surg. 2001 Aug;182(2 Suppl):15S-20S.
Suture support: is it advantageous?
Kjaergard HK.
Department of Cardiothoracic Surgery, Gentofte University Hospital, Niels
Andersens Vej 65, 2900, Hellerup, Denmark. hekja@gentoftehosp.kbhamt.dk
Sutures have been used to facilitate and enhance wound closure and healing
throughout the course of medical history. Suturing is still the most common
method of wound closure, but in some surgical situations suture support can
improve clinical outcomes. Sutures provide mechanical support to a wound and
help create the optimal environment for wound healing. However, suturing can
give rise to such complications as bleeding from suture holes and air and
fluid
leakage. In the last 25 years, fibrin sealants have been used increasingly
in
the clinical setting to assist in the sealing of surgical wounds and to give
additional mechanical support to a range of wounds during the early phases
of
wound healing. The use of fibrin sealants in addition to sutures has a
direct
effect on hemostasis and blood loss. Fibrin sealants also reduce the volume
of
fluid drained and air leakage postoperatively in head, neck, and thoracic
surgery, in some cases resulting in a reduced length of hospital stay. The
use
of fibrin sealant as suture support can also reduce the number of sutures
and
the length of operations for intricate or complex procedures. The aim of
this
article is to provide an overview of how fibrin sealants acting as an
adjunct to
sutures affect surgical outcomes.
Publication Types:
Review
Review, Tutorial
PMID: 11566472 [PubMed - indexed for MEDLINE]
72: Am J Surg. 2001 Aug;182(2 Suppl):1S-7S.
Fibrin sealants in surgical practice: An overview.
Jackson MR.
Department of Surgery, University of Texas Southwestern Medical Center,
Dallas,
Texas 75390-9157, USA. mark.jackson@utsouthwestern.edu
The need to effectively manage hemostasis and tissue sealing during surgery
has
had a strong influence on the development of modern surgical techniques. A
group
of agents known as surgical tissue adhesives has been developed to promote
hemostasis and tissue sealing during surgery, and these comprise both
natural
and synthetic agents. Fibrin sealants are the most effective tissue
adhesives
currently available, and they are biocompatible and biodegradable. The
fibrin
sealants are comprised of purified, virus-inactivated human fibrinogen,
human
thrombin, and sometimes added components, such as virus-inactivated human
factor
XIII and bovine aprotinin. These agents mimic the final steps of the
physiological coagulation cascade to form a fibrin clot. The use of any
plasma-derived product in the surgical setting carries a potential risk of
viral
transmission. In fact, it was the risk of viral transmission from fibrinogen
and
thrombin that halted development work on fibrin sealants in the United States.
Since that time, new techniques for isolating and concentrating plasma
fractions
have been developed, and national and international guidelines have been
introduced to ensure the safety of all plasma products. All plasma donors
are
carefully selected and their plasma units screened for viral contamination
before processing. All plasma donations and bovine tissue used in the
production
of commercial fibrin sealants undergo rigorous viral reduction/elimination
steps. As a result of this carefully controlled and monitored process, there
have been no proven cases of viral transmission associated with the use of
commercial fibrin sealant. Fibrin sealants are currently used in a number of
surgical specialties, including cardiovascular surgery, thoracic surgery,
neurosurgery, plastic and reconstructive surgery, and dental surgery. The
use of
fibrin sealants has a positive effect on surgical outcomes, such as improved
time to hemostasis, reduced blood loss, and reduced complications. This
review
describes the development of fibrin sealants, the composition of currently
available products, and their use in surgical practice.
Publication Types:
Review
Review, Tutorial
PMID: 11566470 [PubMed - indexed for MEDLINE]
73: Dis Esophagus. 2001;14(2):91-4.
Role of laparoscopy and thoracoscopy in the treatment of esophageal
adenocarcinoma.
Oelschlager BK, Pellegrini CA.
University of Washington Medical Center, Department of Surgery, Seattle, WA
98195-6410, USA.
Publication Types:
Review
Review, Tutorial
PMID: 11553215 [PubMed - indexed for MEDLINE]
74: J Thorac Cardiovasc Surg. 2001 Sep;122(3):430-9.
Breaking down barriers: helpful breakthrough statistical methods you need to
understand better.
Blackstone EH.
Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic
Foundation, Cleveland, Ohio 44195, USA. blackse@ccf.org
Publication Types:
Review
Review, Tutorial
PMID: 11547291 [PubMed - indexed for MEDLINE]
75: Orthopedics. 2001 Aug;24(8):789-90.
Chylothorax after video-assisted thoracoscopic release for rigid scoliosis.
Huang TJ, Hsu RW.
Department of Orthopedic Surgery, Chang Gung Memorial Hospital, College of
Medicine, Chang Gung University, Taoyuan, Taiwan.
Publication Types:
Case Reports
Review
Review of Reported
Cases
PMID: 11518410 [PubMed - indexed for MEDLINE]
76: Ann Thorac Surg. 2001 Aug;72(2):577-91.
Tissue engineering: a 21st century solution to surgical reconstruction.
Fuchs JR, Nasseri BA, Vacanti JP.
Massachusetts General Hospital and Harvard Medical School, Boston 02114,
USA.
Tissue engineering has emerged as a rapidly expanding approach to address
the
organ shortage problem. It is an "interdisciplinary field that applies
the
principles and methods of engineering and the life sciences toward the
development of biological substitutes that can restore, maintain, or improve
tissue function." Much progress has been made in the tissue engineering
of
structures relevant to cardiothoracic surgery, including heart valves, blood
vessels, myocardium, esophagus, and trachea.
Publication Types:
Review
Review, Tutorial
PMID: 11515900 [PubMed - indexed for MEDLINE]
77: Semin Thorac Cardiovasc Surg. 2001 Apr;13(2):137-46.
Cardiac risk assessment in noncardiac thoracic surgery.
Kim MH, Eagle KA.
Cardiovascular Division, Washington University in St. Louis, St. Louis, MO,
USA.
Preoperative cardiac risk assessment for noncardiac thoracic surgery is
limited
by the lack of data specific to this type of surgery, especially
prospective,
controlled data. However, the value of clinical predictors in determining
accurate postoperative cardiac outcomes is a reliable tool. Thus, the
approach
is similar to traditional cardiac risk assessment for noncardiac surgery.
The
essential elements of cardiovascular evaluation as it pertains to noncardiac
thoracic surgery are reviewed with a specific focus on coronary artery
disease,
perioperative arrhythmias, and selected topics relevant to noncardiac
thoracic
surgery. The core recommendations of the clinical guidelines by the American
College of Cardiology and American Heart Association are discussed in the
context of noncardiac thoracic surgery. Copyright 2001 by W.B. Saunders Company
Publication Types:
Review
Review, Tutorial
PMID: 11494204 [PubMed - indexed for MEDLINE]
78: Semin Thorac Cardiovasc Surg. 2001 Apr;13(2):92-104.
Preoperative assessment of the thoracic surgery patient: pulmonary function
testing.
Culver BH.
Pulmonary and Critical Care Medicine, University of Washington Medical
Center,
Seattle, WA 98195, USA.
Tests of pulmonary function before thoracic surgery can help to assess the
risk
of perioperative morbidity and mortality, and are the basis for estimating
remaining lung function after resection of lung tissue. Testing has evolved
over
the past 50 years from reliance on the maximum breathing capacity to a range
of
studies including spirometry, and measurement of lung volume, diffusing
capacity, and arterial blood gases, and the interpretation of these in
conjunction with radionuclide scanning. The surgeon must consider both the
early
postoperative decrement in function and the level to which the patient is
expected to recover. Although it is difficult to establish absolute limiting
values, and current surgical techniques are blurring the boundary further,
the
reported experience underlying current guidelines is reviewed. Copyright
2001 by
W.B. Saunders Company
Publication Types:
Review
Review, Tutorial
PMID: 11494200 [PubMed - indexed for MEDLINE]
79: Vet Clin North Am Small Anim Pract. 2001 Jul;31(4):729-59, ix.
Video-assisted thoracoscopy.
Walton RS.
United States Army Institute of Surgical Research, Fort Sam Houston, Texas,
USA.
Thoracoscopy is a minimally invasive operative endoscopic procedure designed
for
visual inspection of the thoracic cavity. The use of small, highly
maneuverable,
rigid telescopes allows visualization beyond what is possible by standard
operative techniques. The use of a small video camera attached to a standard
rigid telescope allows the operator and assistants to view a simultaneous,
enlarged, and clear image. This article focuses on the basic diagnostic and
surgical techniques used in veterinary video-assisted thoracoscopy.
Publication Types:
Review
Review, Tutorial
PMID: 11487953 [PubMed - indexed for MEDLINE]
80: Curr Opin Pulm Med. 2001 Jul;7(4):210-4.
Thoracoscopy in the management of pneumothorax.
Yim AP, Ng CS.
Division of Cardiothoracic Surgery, Department of Surgery, The Chinese
University of Hong Kong, Prince of Wales Hospital, Hong Kong.
yimap@cuhk.edu.hk
Spontaneous pneumothorax is a common condition that impacts significantly on
healthcare expenditure. However, optimal management of spontaneous
pneumothorax
remains a subject of considerable controversy. A thoracic surgeon's
perspective
on the use of thoracoscopy and video-assisted thoracic surgery with a focus
on
surgical techniques in the current management of this condition is
presented.
Publication Types:
Review
Review, Tutorial
PMID: 11470976 [PubMed - indexed for MEDLINE]
81: Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2001;4:216-28.
Reducing the trauma of congenital heart surgery.
Burke RP.
Division of Cardiovascular Surgery, Miami Children's Hospital, FL 331-4069,
USA.
Techniques to reduce surgical trauma for congenital heart repairs continue
to
evolve in tandem with advances in the more conventional protection
strategies.
The concept of chest wall protection has been increasingly accepted as an
important standard for congenital heart surgeons, as long as
neuroprotection,
myocardial protection, and operative precision are not adversely affected.
Unfortunately, it is difficult to measure chest wall trauma, making it
difficult
to evaluate the efficacy of minimally invasive techniques. Efforts to reduce
surgical trauma are advancing on multiple fronts. Many extracardiac repairs
are
being performed thoracoscopically, with excellent results. Intracardiac
procedures can be performed through smaller incisions. Full sternotomy is
giving
way to a variety of sternal-sparing incisions for open-heart repairs,
usually
using direct visualization. Operative strategies to avoid or minimize the
effects of cardiopulmonary bypass have emerged. And recently, hybrid
procedures,
utilizing a combination of transcatheter and minimally invasive techniques,
are
creating new therapeutic options for the congenital heart team.
Publication Types:
Review
Review, Tutorial
PMID: 11460986 [PubMed - indexed for MEDLINE]
82: Chest Surg Clin N Am. 2001 May;11(2):389-405, xi-xii.
Video-assisted thoracoscopy thymectomy for myasthenia gravis.
Mack MJ.
Cardiopulmonary Research Science and Technology Institute, Dallas, Texas,
USA.
Over the past 8 years, the technique of video-assisted thoracoscopic surgery
(VATS) thymectomy has continued to evolve. Although the procedure has become
better defined and greater experience has been gained, numerous issues still
exist. Whether it is best performed through a left sided, right sided, or as
a
bilateral approach with or without a cervical incision, is not clear.
Equivalence of outcomes compared with more standard approaches to thymectomy
is
still an issue. Experience still is relatively limited to a few centers, and
follow-up still is relatively short. In the author's own experience, it
seems
that availability of the less invasive approach has allowed thymectomy to be
performed earlier in the course of the disease especially in young female
patients in whom cosmesis is an important issue.
Publication Types:
Review
Review, Tutorial
PMID: 11413763 [PubMed - indexed for MEDLINE]
83: Chest Surg Clin N Am. 2001 May;11(2):337-61.
Anesthesia and critical care of thymectomy for myasthenia gravis.
Baraka A.
Department of Anesthesiology, American University of Beirut, Beirut,
Lebanon.
abaraka@aub.edu.lb
Myasthenia gravis is an autoimmune disease resulting from the production of
antibodies against the ACh receptors of the neuromuscular synapse. The
thymus
gland is involved in the autosensitization process, and the disease
frequently
is associated with thymic morphologic abnormalities. There is a consensus
that
all adults with generalized MG should have a thymectomy. This recommendation
has
been propagated by the safety of the procedure and excellent outcome.
Removal of
as much thymic tissue as possible (anterior mediastinal exenteration) by
transsternal approach is the logical goal of thymectomy in the treatment of
MG.
Transcervical approach and VATS, however, are less invasive and have been
used
in patients who have MG unaccompanied by thymoma. Optimization of the
condition
of the myasthenic patients can markedly decrease the risk of surgery and
improve
the outcome. Two techniques have been recommended for general anesthesia in
the
myasthenic patient. Because of the unpredictable response to succinylcholine
and
the marked sensitivity to nondepolarizing muscle relaxants, some
anesthesiologists avoid muscle relaxants and depend on deep inhalational
anesthesia, such as halothane, isoflurane, or sevoflurane, for tracheal
intubation and maintenance of anesthesia. Others, however, use a balanced
technique of anesthesia that includes the use of carefully titrated muscle
relaxants. The most important preoperative factor predicting the need for
postoperative mechanical ventilation is the severity of bulbar involvement
(Ossermann group 3 and 4), usually indicated by significant dysphagia and
dysarthria associated with borderline respiratory dysfunction. Thymectomy
benefits nearly 96% of patients: 46% develop complete remission, 50% are
asymptomatic or improve on therapy, and 4% remain the same. The time from
diagnosis to surgery is shorter than 8 months, and mild or moderate
myasthenic
symptoms are the main prognostic factors that predict the best outcome after
thymectomy.
Publication Types:
Review
Review, Tutorial
PMID: 11413760 [PubMed - indexed for MEDLINE]
84: J Am Coll Surg. 2001 Jun;192(6):737-49.
What's new in general thoracic surgery.
Mathisen DJ.
Department of Surgery, Massachusetts General Hospital, Boston 02114, USA.
Publication Types:
Review
Review, Tutorial
PMID: 11400968 [PubMed - indexed for MEDLINE]
85: J Cardiovasc Surg (Torino). 2001 Jun;42(3):291-5.
Transoesophageal echocardiography for minimally invasive cardiac surgery.
Lehot JJ, Blanc P, Arvieux CC, Jegaden O.
Publication Types:
Editorial
Review
Review, Tutorial
PMID: 11398022 [PubMed - indexed for MEDLINE]
86: Practitioner. 2001 May;245(1622):422-4, 426, 428 passim.
Advances in cardiac surgery.
Treasure T.
Cardiothoracic Surgery at Guy's Hospital, London.
Publication Types:
Review
Review, Tutorial
PMID: 11373972 [PubMed - indexed for MEDLINE]
87: Circulation. 2001 May 1;103(17):2133-7.
Sex differences in neurological outcomes and mortality after cardiac
surgery: a
society of thoracic surgery national database report.
Hogue CW Jr, Barzilai B, Pieper KS, Coombs LP, DeLong ER, Kouchoukos NT,
Davila-Roman VG.
Department of Anesthesiology, Cardiovascular Division, Washington University
School of Medicine, St Louis, MO, USA.
BACKGROUND: The purpose of this study was to evaluate whether women
undergoing
cardiac surgery are more likely to suffer neurological complications than
men
and whether these complications could explain, at least in part, their
higher
perioperative mortality. METHODS AND RESULTS: The Society of Thoracic
Surgery
National Cardiac Surgery Database was examined for the years 1996 and 1997
to
determine the frequency of new neurological events (stroke, transient
ischemic
attack, or coma) occurring after cardiac surgery. We reviewed clinical
information on 416 347 patients (32% women) for whom complete neurological
outcome data were available. New neurological events after surgery were
higher
for women than for men (3.8% versus 2.4%, P=0.001). For the whole group, the
30-day mortality was higher for women than for men (5.7% versus 3.5%,
P=0.001),
and among those patients who suffered a perioperative neurological event,
mortality was also significantly higher for women than men (32% versus 28%,
P=0.001). After adjustment for other risk factors (eg, age, history of
hypertension and/or diabetes, duration of cardiopulmonary bypass, and other
comorbid conditions) by multivariable logistic regression, female sex was
independently associated with significantly higher risk of suffering new
neurological events after cardiac surgery (OR 1.21, 95% CI 1.14 to 1.28,
P=0.001). CONCLUSIONS: Women undergoing cardiac surgery are more likely than
men
to suffer new perioperative neurological events, and they have higher 30-day
mortality when these complications occur. The higher incidence of
perioperative
neurological complications in women cannot be explained by currently known
risk
factors.
Publication Types:
Review
Review, Multicase
PMID: 11331252 [PubMed - indexed for MEDLINE]
88: World J Surg. 2001 Feb;25(2):231-7.
Lung volume reduction surgery for chronic obstructive pulmonary disease:
where
do we stand?
McKenna RJ Jr, Gelb A, Brenner M.
Department of Surgery, Cedars-Sinai Medical Center, 8700 Beverly Boulevard,
Los
Angeles, California 90048, USA.
Lung volume reduction surgery (LVRS) is a promising new treatment for
selected
patients with moderate to severe symptoms of emphysema. Medical management,
including pulmonary rehabilitation, has been shown to reduce oxygen requirements
during exercise and probably to reduce hospitalization for patients with
severe
emphysema, but it does not improve pulmonary function. By improving the
elastic
recoil of the lung, LVRS is the first treatment to demonstrate substantial
improvement in pulmonary function and quality of life for selected patients
with
emphysema. The most important selection factor for LVRS is the presence of a
heterogeneous pattern of emphysema. Because it is found in only 20% of
patients
with emphysema, only a small number of patients are candidates for the
procedure. Published reports indicate that the optimal operative technique
appears to be a bilateral staple operation during a single anesthetic. This
procedure offers a 68% chance of oxygen independence, 85% chance of
prednisone
independence, and 60% to 70% improvement in pulmonary function for patients
with
an upper lobe distribution of emphysema. The long-term benefits of the
procedure
are currently unknown, so several randomized, prospective studies are now
comparing LVRS with maximal medical management.
Publication Types:
Review
Review, Tutorial
PMID: 11338026 [PubMed - indexed for MEDLINE]
89: World J Surg. 2001 Feb;25(2):184-8.
Appropriate surgical treatment of resectable non-small-cell lung cancer.
Korst RJ, Ginsberg RJ.
Thoracic Service, Department of Surgery, Room C868, Memorial Sloan-Kettering
Cancer Center, 1275 York Avenue, New York, New York 10021, USA.
korstr@mskcc.org
Patients with early-stage non-small-cell lung cancer (NSCLC) should be
treated
with complete surgical resection whenever possible. Incomplete resections do
not
cure, and the optimal pulmonary resection is anatomic lobectomy. Limited
resections (wedge resection and segmentectomy) are associated with a
threefold
increase in local recurrence, which translates into decreased survival. The
addition of mediastinal lymph node dissection produces the best pathologic
staging but has never been shown to improve survival. Resections can be
performed through a variety of incisions and even using minimally invasive
techniques, but posterolateral thoracotomy seems to provide the best
exposure
and is used most frequently. Adjuvant radiotherapy in both the preoperative
and
postoperative settings does not improve survival in patients with resected
NSCLC. Similarly, postoperative chemotherapy cannot be advocated in these
patients based on the current data. Improved survival has been demonstrated
in
the randomized setting for patients with locally advanced, resectable
disease
(N2) using preoperative (induction) chemo(radio)therapy, but the numbers are
small. Patients with this stage of NSCLC should be enrolled in induction
therapy
protocols whenever possible to confirm the efficacy of this approach.
Publication Types:
Review
Review, Tutorial
PMID: 11338020 [PubMed - indexed for MEDLINE]
90: World J Surg. 2001 Feb;25(2):162-6.
Modern anesthetic techniques for thoracic operations.
Brodsky JB, Fitzmaurice B.
Department of Anesthesiology, H-3580, Stanford University School of
Medicine,
300 Pasteur Drive, Stanford California 94035, USA.
jbrodsky@leland.stanford.edu
Continuing advances in anesthesiology enable surgeons to perform more and
more
complex operations. Nowhere is this relation more important than for the
patient
undergoing thoracic surgery. Specialized anesthetic techniques including
safe
lung separation, the maintenance of oxygenation during selective one-lung
ventilation, and effective postoperative analgesia allow procedures such as
lung
volume reduction surgery and lung transplantation to be performed routinely.
This paper reviews modern clinical practices in the field of thoracic
anesthesia.
Publication Types:
Review
Review, Tutorial
PMID: 11338017 [PubMed - indexed for MEDLINE]
91: World J Surg. 2001 Feb;25(2):157-61.
Place of video-thoracoscopy in thoracic surgical practice.
Yim AP, Lee TW, Izzat MB, Wan S.
Division of Cardiothoracic Surgery, Department of Surgery, Chinese
University of
Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong.
yimap@cuhk.edu.hk
The advent of video-endoscopy revolutionizes the practice of surgery. Within
a
short span of time, video-assisted thoracic surgery (VATS) has become an
acceptable approach to a wide range of thoracic procedures. The use of VATS
as a
diagnostic modality is now well established. For therapeutic procedures,
VATS
has also been generally accepted for the treatment of such conditions as
primary
spontaneous pneumothorax, loculated effusions, thoracodorsal sympathectomy,
and
resection of simple mediastinal cysts. Its roles in more complex procedures
such
as thymectomy and anatemic lung resections, however, remain poorly defined
at
present, even though the existing intermediate-term results are encouraging.
VATS is still in evolution. Miniaturization of instruments promises to
reduce
access-induced trauma even further. On the other hand, attention to
cost-containment is essential if VATS is to be applicable to patients in
developing countries. Technology will continue to change. Carefully
conducted
clinical trials should precede the general acceptance of any new technology,
no
matter how attractive it may appear initially.
Publication Types:
Review
Review, Tutorial
PMID: 11338016 [PubMed - indexed for MEDLINE]
92: Oncologist. 2001;6(2):147-52.
Early lung cancer action project: a summary of the findings on baseline
screening.
Henschke CI, McCauley DI, Yankelevitz DF, Naidich DP, McGuinness G,
Miettinen
OS, Libby D, Pasmantier M, Koizumi J, Altorki N, Smith JP.
Department of Radiology, New York Presbyterian Hospital-Weill Cornell
Medical
Center, 525 East 68th Street, New York, NY 10021, USA.
PURPOSE: The Early Lung Cancer Action Project (ELCAP) is designed to
evaluate
baseline and annual repeat screening by low radiation dose computed
tomography
(low-dose CT) in persons at high-risk for lung cancer. METHODS: Since
starting
in 1993, the ELCAP has enrolled 1,000 asymptomatic persons, 60 years of age
or
older, with at least 10 pack-years (1 pack per day for 10 years, or 2 packs
per
day for 5 years) of cigarette smoking, no prior cancer, and medically fit to
undergo thoracic surgery. After a structured interview and informed consent,
baseline chest radiographs and low-dose CT were obtained on each subject.
The
diagnostic work-up of screen-detected noncalcified pulmonary nodules (NCN)
was
guided by ELCAP recommendations which included short-term high-resolution CT
follow-up for the smallest nodules. Baseline RESULTS: On low-dose CT at
baseline
compared to chest radiography, NCN were detected three times as commonly
(23%
versus 7%), malignancies four times as commonly (2.7% versus 0.7%), and
stage I
malignancies six times as commonly (2.3% versus 0.4%). Of the 27 CT-detected
cancers, 96% (26/27) were resectable; 85% (23/27) were stage I, and 83% (19
of
the 23 stage I) were not seen on chest radiography. Following the ELCAP
recommendations, biopsies were performed on 28 of the 233 subjects with NCN;
27
had a malignant and one a benign NCN. Another three individuals underwent
biopsy
outside of the ELCAP recommendations; all had benign NCNS: No one had
thoracotomy for a benign nodule. CONCLUSION: Baseline CT screening for lung
cancer provides for detecting the disease at earlier and presumably more
commonly curable stages in a cost-effective manner.
Publication Types:
Review
Review, Tutorial
PMID: 11306726 [PubMed - indexed for MEDLINE]
93: AACN Clin Issues. 2000 Aug;11(3):412-23.
Implementation strategy: one-stop recovery for cardiac surgical patients.
Brown MM.
APACHE Medical Systems, Inc. National Health Advisors, McLean, Virginia, USA.
"Fast-track" or "rapid recovery" for cardiac surgical
patients is enjoying
widespread use due to its benefits of increased patient comfort, enhanced
quality of care, and cost-savings. Successful implementation of a fast-track
program, however, may be challenged by physicians, the institution, or
patients
and their families. One-Stop Recovery is a fast-track program that
emphasizes
the benefits of traditional rapid recovery programs while addressing
potential
challenges.
Publication Types:
Review
Review, Tutorial
PMID: 11276655 [PubMed - indexed for MEDLINE]
94: Heart Surg Forum. 1998;1(1):13-6.
State of the art review: videoscopic minimally invasive mitral valve
surgery.
Trekking to a totally endoscopic operation.
Chitwood WR.
Publication Types:
Editorial
Review
Review Literature
PMID: 11276433 [PubMed - indexed for MEDLINE]
95: Chest Surg Clin N Am. 2001 Feb;11(1):1-16, vii.
Surgical oncologic principles.
Goldstraw P.
Department of Thoracic Surgery, Royal Brompton Hospital, London, England.
p.goldstraw@rbh.nthames.nhs.uk
In this article, there is a return to the beginning of the last century,
retracing the evolution of the lung cancer epidemic. As lung cancer
increased in
frequency, the steps developed to investigate and treat the disease are
recalled. At the beginning of the new millennium, the position of surgery in
the
management of lung cancer is summarized. The role of the surgeon in the
investigation and treatment of lung cancer, whether with curative or
palliative
intent, is evaluated. The principles of surgical management are enunciated,
how
these principles are presently understood is discussed, and how the disease,
its
prevention, and treatment may develop in the new millennium is addressed.
Publication Types:
Review
Review, Tutorial
PMID: 11253592 [PubMed - indexed for MEDLINE]
96: Anesthesiol Clin North America. 2001 Mar;19(1):153-71.
Anesthesia for thoracoscopy.
Shah JS, Bready LL.
Department of Anesthesiology, University of Texas Health Science Center at
San
Antonio, San Antonio, Texas, USA.
Thoracoscopy has become a widely used method of achieving minimally invasive
thoracic surgery. The anesthesiologist providing perioperative care for VATS
is
challenged to evaluate the patient carefully; to design a safe anesthetic
regimen, taking into account preexisting disorders; to ameliorate
physiologic
alterations associated with one-lung ventilation and CO2 insufflation; and
to
provide safe, effective perioperative anesthesia and postoperative pain
control.
Publication Types:
Review
Review, Tutorial
PMID: 11244915 [PubMed - indexed for MEDLINE]
97: Curr Opin Cardiol. 2001 Mar;16(2):146-51.
Robotic cardiac valve surgery: transcending the technologic crevasse!
Felger JE, Nifong LW, Chitwood WR Jr.
Department of Surgery, Robotics and Minimally Invasive Training Center,
Brody
School of Medicine, East Carolina University, Greenville, NC 27858, USA.
"The man with a new idea is a crank until the idea
succeeds."--Mark Twain. With
the profound public stress for minimally invasive surgery that guided
General
Surgery, Cardiothoracic Surgery has progressed with warranted enthusiasm.
The
explosion of technological advancements in optics, instrumentation and
cardiopulmonary bypass has permitted minimally invasive cardiac procedures
to be
performed with safety, efficiency, and efficacy.In this chapter, we review
the
evolution of minimally invasive cardiac valve surgery. The articles of
leading
minimally invasive valve surgeons, both European and American, are reviewed.
The
indications for minimally invasive surgery are explained. Furthermore, the
present day state of "robotic" mitral valve surgery is described.
Publication Types:
Review
Review, Tutorial
PMID: 11224648 [PubMed - indexed for MEDLINE]
98: Ann Ital Chir. 2000 Sep-Oct;71(5):539-43.
Video-assisted thoracic surgery--state of the art.
Weissberg D, Schachner A.
Video-assisted thoracic surgery (VATS) is one of the main medical
revolutions of
the past decade. For its satisfactory performance, the following
prerequisites
are essential: (1) knowledge and experience in thoracic surgery; (2) team of
experienced anesthesiologists; (3) preoperative assessment of respiratory
function; (4) adequate postoperative care; and (5) instruments specially
designed for thoracoscopic surgery. VATS is routinely performed under
general
anesthesia with double lumen endotracheal intubation for separate control of
each lung. Insufflation of carbon dioxide must not exceed 1-3 mm Hg. Too
high
pressure may cause harmful reduction of venous return and mediastinal shift
with
impairment of ventilation. Presence of adhesions should be determined by
finger
exploration of the pleural cavity. Operative ports should be placed
carefully,
avoiding damage to the intercostal nerves and vessels. The video technique
can
be used with efficiency for the following indications: pneumothorax,
resection
of pulmonary nodules, biopsies of lung, pleura and mediastinal structures,
resection of mediastinal tumors, management of empyema, and hemostasis and
closure of lacerations after trauma. Indications for esophageal procedures
include esophagomyotomy for achalasia and resections of benign lesions.
Repair
of perforated esophagus is a matter of controversy, but in early stages it
can
be done thoracoscopically. Although video-pericardioscopy has been performed
by
some surgeons, this procedure can be done easier and faster using the direct
approach without the video equipment. There are differences of opinion with
regard to major pulmonary and esophageal resections for cancer. The apparent
advantage of diminished pain is offset by inadequate resection, spread of
malignant cells and potential damage to the resected specimen with loss of
important information concerning pathology. Complications of VATS are few,
and
include prolonged air leak, dysrhythmia, respiratory failure, bleeding and
infection. Due to progress over the past several years, VATS has become an
inseparable part of thoracic surgery and should be included in the basic
training of every thoracic surgeon.
Publication Types:
Editorial
Review
Review, Tutorial
PMID: 11217470 [PubMed - indexed for MEDLINE]
99: Arq Bras Cardiol. 1999 Oct;73(4):383-90.
Chylothorax after myocardial revascularization with the left internal
thoracic
artery.
Pego-Fernandes PM, Ebaid GX, Nouer GH, Munhoz RT, Jatene FB, Jatene AD.
Instituto do Coracao, Sao Paulo, SP, 05403-000.
A 38-year-old male underwent coronary artery bypass grafting (CABG). A
saphenous
vein graft was attached to the left marginal branch. The left internal
thoracic
artery was anastomosed to the left anterior descending artery (LAD). The
early
recovery was uneventful and the patient was discharged on the 5th
postoperative
day. After three months, he came back to the hospital complaining of weight
loss, weakness, and dyspnea on mild exertion. Chest X-rays showed left
pleural
effusion. On physical examination, a decreased vesicular murmur was
detected.
After six days, the diagnosis of chylothorax was made after a milky fluid
was
detected in the plural cavity and total pulmonary expansion did not occur.
On
the next day, both anterior and posterior pleural drainage were performed by
videothoracoscopy, and prolonged parenteral nutrition (PPN) was instituted
for
ten days. After seven days the patient was put on a low-fat diet for 8 days.
The
fluid accumulation ceased, the drains were removed and the patient was
discharged with normal pulmonary expansion.
Publication Types:
Case Reports
Review
Review of Reported
Cases
PMID: 10754592 [PubMed - indexed for MEDLINE]
100: Semin Thorac Cardiovasc Surg. 2000 Oct;12(4):301-6.
Minimally invasive approaches to mediastinal neoplasms.
Kelemen JJ 3rd, Naunheim KS.
Division of Cardiothoracic Surgery, St. Louis University Health Science
Center,
St. Louis, MO 63110-2914, USA.
The goal of minimal-access surgery is to cause the least trauma necessary to
gain exposure for an operative procedure. Application of this principle to
mediastinal neoplasms involves the use of small incisions with both
mediastinoscopy and video-assisted thoracoscopic surgery (VATS). The
mediastinum
is divided into anterior, middle, and posterior compartments, and this
anatomy
provides a framework for discussion of diagnostic and therapeutic
procedures.
Neoplasms occur with a characteristic frequency that varies with age and
location. Neurogenic tumors and thymic neoplasms account for one third of
all
masses. Knowledge of the potential cause of a neoplasm and the surrounding
anatomy provides the context for determining the surgical approach. The
operative indications and goals of a procedure should not be significantly
affected by the operative approach. Conversion from a minimal-access
approach to
a more traditional incision should be an anticipated possibility that is
often
undertaken as the next logical step rather than an expression of
exasperation.
Copyright 2000 by W.B. Saunders Company
Publication Types:
Review
Review, Tutorial
PMID: 11154725 [PubMed - indexed for MEDLINE]
101: Can Respir J. 2000 Nov-Dec;7(6):491-5.
Hydroxyurea-induced hypersensitivity pneumonitis: A case report and
literature
review.
Sandhu HS, Barnes PJ, Hernandez P.
Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax,
Canada.
Hydroxyurea is a cytotoxic agent indicated in the treatment of a variety of
malignant and nonmalignant conditions. Apart from dose-related bone marrow
suppression, this antineoplastic agent is generally well tolerated. This
report
describes a patient with chronic myeloid leukemia who developed severe
pneumonitis within four weeks of beginning therapy with hydroxyurea.
Pathological examination of a lung specimen obtained by video-assisted
thoracoscopic lung biopsy revealed extensive active alveolar and
interstitial
inflammation, and poorly formed granulomas. After the cessation of
hydroxyurea
and treatment with systemic corticosteroids, both clinical and radiological
resolution of pneumonitis occurred. Physicians using hydroxyurea must be
aware
of its potentially life-threatening pulmonary toxicity.
Publication Types:
Case Reports
Review
Review of Reported
Cases
PMID: 11121094 [PubMed - indexed for MEDLINE]
102: Eur J Cardiothorac Surg. 2000 Dec;18(6):711-6.
Surgical aspects of chronic post-thoracotomy pain.
Rogers ML, Duffy JP.
Department of Cardiothoracic Surgery, Nottingham City Hospital, Hucknall
Road,
NG5 1PB, Nottingham, UK. mrogers999@hotmail.com
Chronic post-thoracotomy pain is a continuous dysaesthetic burning and
aching in
the general area of the incision that persists at least 2 months after
thoracotomy. It occurs in approximately 50% of patients after thoracotomy
and is
usually mild or moderate. However, in 5% the pain is severe and disabling.
No
one technique of thoracotomy has been shown to reduce the incidence of chronic
postthoracotomy pain. The most likely cause is intercostal nerve damage,
although the precise mechanism for this is not known. Future work needs to
examine surgical technique in detail. Until then, patients need to be
adequately
warned of this sequela of thoracotomy.
Publication Types:
Review
Review, Tutorial
PMID: 11113680 [PubMed - indexed for MEDLINE]
103: Chest Surg Clin N Am. 2000 Nov;10(4):803-20.
Lung cancer. Surgical approaches and incisions.
Dewey TM, Mack MJ.
Cardiopulmonary Research Science and Technology Institute, Dallas, Texas,
USA.
With the emphasis of current surgical practice being increasingly focused on
reducing the invasiveness of procedures, new techniques and concepts are
changing the approach to thoracic surgery. Robotics offers the benefits of
scaled motion, tremor filtration, and remote telemanipulation. It may be
theoretically possible to introduce the concept of telementoring into
thoracic
surgery. By coupling two consoles, it would be possible for a senior surgeon
to
guide a junior surgeon through an endoscopic procedure in which the
clinicians
were in different locations. The use of telepresence surgery would also
enable
surgeons to perform or assist in operations taking place in remote locations.
Robotics has the potential to increase the applicability of endoscopic
surgery
to an increasing number of patients with technically complex thoracic
problems.
Given that this technology is in its infancy, it remains too early in the
process to determine if robotics will be a significant
"value-added" element of
cardiothoracic surgery; however, the possibilities continue to be limited
only
by imagination and ingenuity.
Publication Types:
Review
Review, Tutorial
PMID: 11091927 [PubMed - indexed for MEDLINE]
104: Chest Surg Clin N Am. 2000 Nov;10(4):763-79, vii.
Lung cancer. Diagnostic tools.
Goldberg M, Unger M.
Division of Thoracic Oncologic Surgery, Fox Chase Cancer Center,
Philadelphia,
Pennsylvania, USA.
Early diagnosis of lung cancer represents the best method for improving
survival
rates. The diagnostic aids available have improved exponentially on old and
new
techniques over the past 20 years. The greatest impact has been in computed
tomography and positron emission tomography scanning imaging techniques. In
the
future, these techniques will improve, and others such as monoclonal
antibody
scans and antisense imaging techniques will certainly further enhance the
physician's ability to diagnose earlier, and thereby, treat earlier.
Publication Types:
Review
Review, Tutorial
PMID: 11091925 [PubMed - indexed for MEDLINE]
105: Curr Probl Surg. 2000 Nov;37(11):733-858.
Complications of general thoracic surgery.
Pezzella AT, Adebonojo SA, Hooker SG, Mabogunje OA, Conlan AA.
Department of Surgery, University of Massachusetts Medical Center,
Worcester,
USA.
Publication Types:
Review
Review, Academic
PMID: 11082724 [PubMed - indexed for MEDLINE]
106: Ann Oncol. 2000;11 Suppl 3:97-9.
Role of minimal invasive therapy in non-small cell lung cancer.
Pastorino U.
European Institute of Oncology, Milan, Italy.
Publication Types:
Review
Review, Tutorial
PMID: 11079125 [PubMed - indexed for MEDLINE]
107: Surg Clin North Am. 2000 Oct;80(5):1543-53.
Thoracoscopic evaluation and treatment of pulmonary disease.
McKenna RJ Jr.
Section of Thoracic Surgery, Cedars Sinai Medical Center, Los Angeles,
Californa
90048, USA.
VATS wedge resection and lobectomy can be performed with reasonable
morbidity
and mortality. A cautious approach is appropriate for VATS lobectomy with
proper
patient selection, and the completeness of the cancer surgery should not be
compromised. Only surgeons with the VATS skills that allow them to perform
complex procedures should perform the procedure.
Publication Types:
Review
Review, Tutorial
PMID: 11059719 [PubMed - indexed for MEDLINE]
108: Surg Clin North Am. 2000 Oct;80(5):1535-42.
Thoracoscopic evaluation and treatment of thoracic trauma.
Lowdermilk GA, Naunheim KS.
Division of Cardiothoracic Surgery, Saint Louis University Health Sciences
Center, Missouri 63110-0250, USA.
VATS has a diagnostic and therapeutic role in the treatment of patients with
chest trauma, but the basic rule of safety over technology must be applied.
It
is an effective means for managing diaphragmatic injuries, hemothorax,
empyemas,
and persistent air leaks in selected hemodynamically stable patients. An
overview of reported series (Table 1) demonstrates that VATS can be used
successfully in the evaluation of patients with blunt and penetrating
trauma. In
appropriately selected cases, thoracoscopy can prove to be useful, with
conversion to thoracotomy in only 10% of patients. Additional studies must
be
performed to determine any cost benefit compared with conventional therapy.
Publication Types:
Review
Review, Tutorial
PMID: 11059718 [PubMed - indexed for MEDLINE]
109: Surg Clin North Am. 2000 Oct;80(5):1511-33.
Video-assisted thoracic surgery for diseases within the mediastinum.
Lin JC, Hazelrigg SR, Landreneau RJ.
Division of General Thoracic Surgery, Allegheny General Hospital,
Pittsburgh,
Pennsylvania, USA.
VATS and concepts of minimal access thoracic surgery have revitalized many
aspects of general thoracic surgery, including the surgical approach to
diseases
and conditions of the mediastinum. Proven surgical options that have been
shunned by patients and referring physicians because of the perceived
morbidity
of thoracotomy have been reconsidered with the emergence of these minimal
access
surgical options. Continued critical review of the accumulating experience
in
VATS techniques will refine the surgical indications for VATS and open
thoracotomy.
Publication Types:
Review
Review, Tutorial
PMID: 11059717 [PubMed - indexed for MEDLINE]
110: Monaldi Arch Chest Dis. 2000 Aug;55(4):299-304.
Operative staging of lung cancer.
Van Schil PE, Van den Brande F, De Maeseneer MG.
Dept of Surgery, University Hospital of Antwerp, Edegem, Belgium.
For earlier stage non-small cell lung cancer, surgical resection remains the
most effective therapy. Complete resection of the primary tumour and lymph
nodes
should be the final aim in order to obtain the best long-term prognosis.
Resectability depends on the tumour stage, and precise pre- and peroperative
staging are of the utmost importance. In some cases, lung-sparing or
extended
operations are indicated. Despite modern scanning techniques, invasive
staging
by mediastinoscopy or thoracoscopy often remains necessary for determining
resectability or deciding on a specific treatment. During thoracotomy,
precise
evaluation of the tumour and node factor is imperative for determining the
extent of resection and achieving a complete tumour clearance. A systematic
nodal dissection during thoracotomy is advised. Lung resection after
induction
therapy remains a technical challenge, especially after combined
chemoradiotherapy. Peroperative staging is often difficult as distinction
between viable tumour and fibrotic reaction is not easily made. Although
combined modality treatment has an overall increased morbidity and mortality
rate, it improves survival in selected cases of locally advanced non-small
cell
lung cancer.
Publication Types:
Case Reports
Review
Review, Tutorial
PMID: 11057083 [PubMed - indexed for MEDLINE]
111: Chest. 2000 Oct;118(4):1158-71.
Erratum in:
Chest 2001
Jan;119(1):319.
Medical and surgical treatment of parapneumonic effusions : an
evidence-based
guideline.
Colice GL, Curtis A, Deslauriers J, Heffner J, Light R, Littenberg B, Sahn
S,
Weinstein RA, Yusen RD.
Pulmonary and Respiratory Services, Washington Hospital Center, Washington,
DC,
USA.
OBJECTIVE: A panel was convened by the Health and Science Policy Committee
of
the American College of Chest Physicians to develop a clinical practice
guideline on the medical and surgical treatment of parapneumonic effusions
(PPE)
using evidence-based methods. OPTIONS AND OUTCOMES CONSIDERED: Based on
consensus of clinical opinion, the expert panel developed an annotated table
for
evaluating the risk for poor outcome in patients with PPE. Estimates of the
risk
for poor outcome were based on the clinical judgment that, without adequate
drainage of the pleural space, the patient with PPE would be likely to have
any
or all of the following: prolonged hospitalization, prolonged evidence of
systemic toxicity, increased morbidity from any drainage procedure,
increased
risk for residual ventilatory impairment, increased risk for local spread of
the
inflammatory reaction, and increased mortality. Three variables, pleural
space
anatomy, pleural fluid bacteriology, and pleural fluid chemistry, were used
in
this annotated table to categorize patients into four separate risk levels
for
poor outcome: categories 1 (very low risk), 2 (low risk), 3 (moderate risk),
and
4 (high risk). The panel's consensus opinion supported drainage for patients
with moderate (category 3) or high (category 4) risk for a poor outcome, but
not
for patients with very low (category 1) or low (category 2) risk for a poor
outcome. The medical literature was reviewed to evaluate the effectiveness
of
medical and surgical management approaches for patients with PPE at moderate
or
high risk for poor outcome. The panel grouped PPE management approaches into
six
categories: no drainage performed, therapeutic thoracentesis, tube
thoracostomy,
fibrinolytics, video-assisted thoracoscopic surgery (VATS), and surgery
(including thoracotoiny with or without decortication and rib resection).
The
fibrinolytic approach required tube thoracostomy for administration of drug,
and
VATS included post-procedure tube thoracostomy. Surgery may have included
concomitant lung resection and always included postoperative tube
thoracostomy.
All management approaches included appropriate treatment of the underlying
pneumonia, including systemic antibiotics. Criteria for including articles
in
the panel review were adequate data provided for >/=20 adult patients
with PPE
to allow evaluation of at least one relevant outcome (death or need for a
second
intervention to manage the PPE); reasonable assurance provided that drainage
was
clinically appropriate (patients receiving drainage were either category 3
or
category 4) and drainage procedure was adequately described; and original
data
were presented. The strength of panel recommendations on management of PPE
was
based on the following approach: level A, randomized, controlled trials with
consistent results or individual randomized, controlled trial with narrow
confidence interval (CI); level B, controlled cohort and case control
series;
level C, historically controlled series and case series; and level D, expert
opinion without explicit critical appraisal or based on physiology, bench
research, or "first principles." EVIDENCE: The literature review
revealed 24
articles eligible for full review by the panel, 19 of which dealt with the
primary management approach to PPE and 5 with a rescue approach after a
previous
approach had failed. Of the 19 involving the primary management approach to
PPE,
there were 3 randomized, controlled trials, 2 historically controlled
series,
and 14 case series. The number of patients included in the randomized
controlled
trials was small; methodologic weaknesses were found in the 19 articles
describing the results of primary management approaches to PPE. The
proportion
and 95% CI of patients suffering each of the two relevant outcomes (death
and
need for a second intervention to manage the PPE) were calculated for the
pooled
data for each management approach from the 19 articles on the primary
management
approach. (ABST
Publication Types:
Consensus
Development Conference
Guideline
Meta-Analysis
Practice Guideline
Review
PMID: 11035692 [PubMed - indexed for MEDLINE]
112: Thorax. 1999 Apr;54 Suppl 1:S1-14.
The diagnosis, assessment and treatment of diffuse parenchymal lung disease
in
adults. Introduction.
[No authors listed]
Publication Types:
Review
Review, Tutorial
PMID: 11006787 [PubMed - indexed for MEDLINE]
113: Chest. 2000 Sep;118(3):577-9.
Comment on:
Chest. 2000
Sep;118(3):808-13.
Pleurodesis: everything flows.
Bouros D, Froudarakis M, Siafakas NM.
Publication Types:
Comment
Editorial
Review
Review, Tutorial
PMID: 10988174 [PubMed - indexed for MEDLINE]
114: Postgrad Med J. 2000 Sep;76(899):547-50.
Video assisted thoracoscopic surgery.
Stoica SC, Walker WS.
Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh,
Lauriston
Place, Edinburgh EH3 9YW, UK.
Publication Types:
Review
Review, Tutorial
PMID: 10964116 [PubMed - indexed for MEDLINE]
115: Surg Today. 2000;30(8):739-43.
Encapsulated pericardial fat necrosis treated by video-assisted thoracic
surgery: report of a case.
Inoue S, Fujino S, Tezuka N, Sawai S, Kontani K, Hanaoka J, Ichinose M.
Second Department of Surgery, Shiga University of Medical Science, Seta,
Otsu,
Japan.
A 55-year-old moderately obese man who was admitted to a local hospital
following a traffic accident reported having experienced an episode of sharp
and
sudden pleuritic pain in the left anterior lower chest 2 days earlier. A
computed tomographic scan on admission demonstrated a nonhomogeneous mass in
the
anterior left side of the chest, abutting the left cardiac margin, and a
left-sided pleural effusion. As a mediastinal tumor was suspected, he was
referred to our hospital for investigation and treatment. An exploratory
thoracotomy was performed by video-assisted thoracic surgery (VATS) about 3
weeks later, which revealed a firm, yellowish mass on the oral side of the
pericardial fat pad, adhering to the anterior chest wall. The mass was
easily
removed. The resected specimen consisted of a lobulated fragment of adipose
tissue measuring 5.0 x 3.5 x 2.0 cm, and the final pathologic diagnosis was
pericardial fat necrosis. The patient had an uneventful postoperative
recovery
and has remained free of symptoms for 10 months since his operation.
Pericardial
fat necrosis remains a rare clinical entity. Surgical excision by VATS
achieves
symptomatic cure and probably continues to be the treatment of choice
because of
the need to exclude a neoplasm in the differential diagnosis.
Publication Types:
Case Reports
Review
Review of Reported
Cases
PMID: 10955740 [PubMed - indexed for MEDLINE]
116: J Am Acad Orthop Surg. 2000 May-Jun;8(3):159-69.
Thoracic disk disease: diagnosis and treatment.
Vanichkachorn JS, Vaccaro AR.
Department of Orthopaedics, Thomas Jefferson University Hospital,
Philadelphia,
PA, USA.
Symptomatic degenerative disk disease is much less common in the thoracic
spine
than in the cervical and lumbar regions. Accurate diagnosis relies on a
strong
clinical suspicion that is confirmed with appropriate diagnostic imaging.
Presenting symptoms vary tremendously, from atypical pain patterns to
myelopathy. The use of computed tomography in combination with myelography
and
magnetic resonance imaging have greatly increased the ability to accurately
visualize thoracic spine disorders. The superior resolution of available
imaging
modalities has made the incidental detection of asymptomatic thoracic disk
abnormalities more frequent. Most patients with symptomatic thoracic disk
disease will respond favorably to nonoperative management. Surgery is
indicated
for the rare patient with an acute thoracic disk herniation with progressive
neurologic deficit (i.e., signs or symptoms of thoracic spinal cord
myelopathy).
Once surgical intervention has been chosen, careful preoperative planning is
necessary. The level, anatomic location, and morphology of the herniation
must
be precisely determined to select the optimal approach. Posterior
laminectomy
has largely been abandoned for the treatment of symptomatic thoracic disk
protrusions. Surgeons still may choose among anterior, lateral, and
posterior
approaches when surgically addressing the thoracic intervertebral disk.
Publication Types:
Review
Review, Tutorial
PMID: 10874223 [PubMed - indexed for MEDLINE]
117: Ann Thorac Cardiovasc Surg. 2000 Apr;6(2):81-5.
Present status of spontaneous pneumothorax in Japan.
Takeno Y.
Pneumothorax-Center, Nissan Tamagawa Hospital, 4-8-1 Seta, Setagaya-ku,
Tokyo
158-0095, Japan.
Today, spontaneous pneumothorax (SPT) is a common disease in Japan. It is
easy
to diagnose but difficult to estimate how to manage it. The curative
treatment
of SPT is resection of the ruptured bulla. In Japan, almost all surgical
cases
of SPT are operated by video-assisted thoracic surgery (VATS). The
recurrence
rate after VATS is only a few percent in our center. The cause of recurrence
is
usually attributable to overlooking bullae and newly developed bullae. Newly
developed devices in Japan which help to reduce the recurrence rate are
presented, and the Japan Association for Pneumothorax (JASP) and the
Pneumothorax Center are introduced.
Publication Types:
Review
Review, Tutorial
PMID: 10869999 [PubMed - indexed for MEDLINE]
118: Can J Cardiol. 2000 Jun;16(6):765-75.
Planning for cardiac surgical services: advice from an Ontario consensus
panel.
For the Consensus Panel on Cardiac Surgical Services in Ontario and the
Steering
Committee of the Cardiac Care Network of Ontario.
Scully H, Vimr MA, Jutte N, Thompson GG.
University of Toronto, The Toronto General Hospital, Canada.
The Cardiac Care Network of Ontario (CCN) Consensus Panel on Cardiac
Surgical
Services drew on the literature and its own expertise to recommend
guidelines
for expanding services. This report, which is not an official position paper
of
the Canadian Cardiovascular Society, presents these recommendations. Rates
of
surgery are linked to diagnostic capacity, requiring increases in
interventional
therapies to match increases in invasive diagnostic activity. For quality
and
efficiency, panel members recommend an annual minimum of 150 procedures per
surgeon and 500 per centre; a centre should serve a minimum population of
500,000. Services should be as close to patients' homes as possible while
maintaining recommended volumes. Expanding the CCN's cardiac surgery
database to
include other cardiac modalities will yield a more accurate assessment of
waiting times. The panel recommends collaborative regional planning
associations, mentorship arrangements between new and existing centres,
prompt
action on human resource shortages and exploration of alternative funding
models.
Publication Types:
Consensus
Development Conference
Review
PMID: 10863168 [PubMed - indexed for MEDLINE]
119: Radiol Clin North Am. 2000 May;38(3):545-61, ix.
Staging and the surgical management of lung cancer.
Park BJ, Louie O, Altorki N.
Department of Cardiothoracic Surgery, New York Presbyterian Hospital, New
York,
USA.
Small cell lung cancer remains a nonsurgical disease with the majority (80%)
of
cases presenting in higher stages. The primary treatment modalities for
small
cell lung cancer are radiation therapy and systemic chemotherapy, often
administered concomitantly. This article focuses on the staging and surgical
management of non-small-cell lung cancer.
Publication Types:
Review
Review, Tutorial
PMID: 10855261 [PubMed - indexed for MEDLINE]
120: Radiol Clin North Am. 2000 May;38(3):535-44.
Semi-invasive and invasive procedures for the diagnosis and staging of lung
cancer. II. Bronchoscopic and surgical procedures.
Bogot NR, Shaham D.
Department of Radiology, Kupat Cholim Klalit, Jerusalem, Israel.
Each of the various techniques used for the diagnosis and staging of lung
cancer
has its advantages and limitations (Table 1). Imaging has a major role in
guiding these procedures and deciding which of them is most appropriate in a
given clinical setting. A CT examination by which the size and location of
the
parenchymal lesion and the presence and location of enlarged lymph nodes can
be
determined is a prerequisite for all sampling procedures. As a general rule,
when attempting to diagnose a solitary pulmonary nodule or mass, central
lesions
are more easily approached by the bronchoscopic route, whereas a
transthoracic
route is preferred for peripheral lesions. Bronchoscopy is often performed
using
fluoroscopic guidance, and the recently developed CT fluoroscopy and
endoscopic
ultrasound have the potential to facilitate transbronchial needle
aspiration. A
recent advent in imaging of lung cancer has been the introduction of
positron
emission tomography to the diagnostic work-up of lung cancer. Although this
technique has been shown to be highly accurate in determining the malignant
or
benign nature of lesions, it does not enable histologic diagnosis. In each
case,
the most appropriate diagnostic procedure should be tailored to suit the
specific requirements determined by the characteristics of the disease
process,
institutional availability of the various diagnostic procedures, and patient
preferences, when possible.
Publication Types:
Review
Review, Tutorial
PMID: 10855260 [PubMed - indexed for MEDLINE]
121: Surg Clin North Am. 2000 Apr;80(2):633-57.
Secondary pulmonary malignancy.
Greelish JP, Friedberg JS.
Department of Surgery, Hospital of the University of Pennsylvania,
Philadelphia,
USA.
Patients with pulmonary metastases were previously relegated to palliative
medical management. Since the first metastasectomies in the nineteenth
century,
general acceptance of this technique has occurred. Although, initially,
indications for resection of pulmonary metastases were limited to patients
with
solitary nodules, over time, indications have broadened to include multiple
lesions, recurrent disease, and nearly all histologies. With appropriate
patient
selection and the absence of extrathoracic disease, survival may be
improved.
For patients with disseminated and symptomatic disease, surgical therapy may
also provide some relief.
Publication Types:
Review
Review, Tutorial
PMID: 10836010 [PubMed - indexed for MEDLINE]
122: J Accid Emerg Med. 2000 May;17(3):165-9.
Current opinions and practices in the treatment of spontaneous pneumothorax.
Chan SS.
Department of Accident and Emergency, Prince of Wales Hospital, Chinese
University of Hong Kong, Shatin, NT. saukau@netvigator.com
The approach to the initial management of spontaneous pneumothorax differs
markedly from centre to centre, and it is difficult in practice to establish
a
standard protocol. This article reviews the concepts behind the British
Thoracic
Society guidelines, and reports the varying opinions and alternative
practices
existing currently. There is a need for more evidence-based studies to
identify
what is the best approach. Based on a review of relevant recent reports, the
author attempts to work out an unbiased practical approach that can be used
safely and that can possibly give the best overall cost effective results.
Publication Types:
Review
Review, Tutorial
PMID: 10819376 [PubMed - indexed for MEDLINE]
123: Curr Opin Pulm Med. 1998 Jul;4(4):243-6.
Thoracoscopy in the management of hemothorax and retained blood after
trauma.
Carrillo EH, Richardson JD.
Department of Surgery, University of Louisville School of Medicine, The
Center
for Advanced Surgical Technologies and Alliant Community Trust Fund,
Louisville,
KY 40232, USA.
Retained hemothorax complicated by blood clotting in the thoracic cavity
traditionally has been treated with open thoracotomy for evacuation of the
hemothorax and cleaning of the thoracic cavity. Recent improvements in video
technology and endoscopic surgical instruments have fostered renewed
interest in
video-assisted thoracoscopic surgery to diagnose and treat a variety of
surgical
conditions of the chest, which classically were managed exclusively by
thoracotomy. Posttraumatic retained hemothorax currently is being managed at
most institutions by video-assisted thoracoscopic surgery, with consistently
good results.
Publication Types:
Review
Review, Tutorial
PMID: 10813242 [PubMed - indexed for MEDLINE]
124: Chest Surg Clin N Am. 2000 May;10(2):329-39, vii.
Minimally invasive pectus surgery.
Hebra A.
Department of Surgery, Medical University of South Carolina, Charleston,
USA.
hebraa@musc.edu
The technique of minimally invasive repair of pectus excavatum is a new
operation that allows for repair of this deformity without any cartilage
resection or sternal osteotomy. The procedure has revolutionized the
management
of pectus excavatum. The innovative incorporation of thoracoscopic
techniques
and small but important modifications to the technique have made this
operation
very effective and safe.
Publication Types:
Review
Review, Tutorial
PMID: 10803337 [PubMed - indexed for MEDLINE]
125: Ann Thorac Surg. 2000 Apr;69(4 Suppl):S369-72.
Congenital Heart Surgery Nomenclature and Database Project: palliation,
correction, or repair?
Joffs C, Sade RM.
Department of Surgery, Medical University of South Carolina, Charleston
29425,
USA.
BACKGROUND: Inconsistent use of the terms palliation, repair, and
correction,
fosters unclear thinking about the goals of cardiac operation. Actual usage
of
these terms has not been previously documented. METHODS: Every article, for
two
years, pertaining to congenital heart disease in The Annals of Thoracic
Surgery
and The Journal of Thoracic and Cardiovascular Surgery was systematically
inspected for terms of classification. RESULTS: In the 301 articles
reviewed,
repair and correction were used virtually interchangeably. Palliation was
generally used distinctively, but all 3 descriptors were used for 3
operations.
The etymology of each descriptive term suggests that they have distinct
traditional definitions and connotations. Repair suggests returning to
normal
that which was once normal, while correction carries no implication of prior
normalcy; thus, correction is the more etymologically correct term for
congenital heart operations. In current literature, palliation is used
improperly for a few operations to denote lack of anatomic correction or
lack of
permanence of correction. CONCLUSIONS: Because proper usage reflects both
etymology and actual usage, we suggest that repair and correction may be
used
interchangeably. Palliation, however, should describe only operations that
are
not intended to provide normal cardiac physiology.
Publication Types:
Review
Review, Tutorial
PMID: 10798442 [PubMed - indexed for MEDLINE]
126: Ann Thorac Surg. 2000 Apr;69(4 Suppl):S358-68.
Congenital Heart Surgery Nomenclature and Database Project: cardiac tumors.
Mehta SM, Myers JL.
Pediatric Cardiovascular Surgery, Children's Hospital, Milton S. Hershey
Medical
Center, Pennsylvania State University, Hershey 17033, USA.
The extant nomenclature for cardiac tumors is reviewed for the purpose of
establishing a unified reporting system. The subject was debated and
reviewed by
members of the STS-Congenital Heart Surgery Database Committee and
representatives from the European Association for Cardiothoracic Surgery.
All
efforts were made to include all relevant nomenclature categories using
synonyms
where appropriate. Cardiac tumors are characterized as primary, tumors which
arise directly from tissues of the heart, and secondary, tumors which arise
from
tissues distant from the heart, with subsequent spread to the otherwise
normal
tissues of the heart. Tumor types are noted in the hierarchical scheme. A
comprehensive database set is presented which is based on a hierarchical
scheme.
Data are entered at various levels of complexity and detail which can be
determined by the clinician. These data can lay the foundation for
comprehensive
risk stratification analyses. A minimum database set is also presented which
will allow for data sharing and would lend itself to basic interpretation of
trends.
Publication Types:
Review
Review, Tutorial
PMID: 10798441 [PubMed - indexed for MEDLINE]
127: Ann Thorac Surg. 2000 Apr;69(4 Suppl):S343-57.
Congenital Heart Surgery Nomenclature and Database Project: end-stage lung
disease.
Gaynor JW, Bridges ND, Spray TL.
Division of Pediatric Cardiothoracic Surgery, The Cardiac Center at The
Children's Hospital of Philadelphia, Pennsylvania 19104, USA.
gaynor@email.chop.edu
The extant nomenclature for end-stage lung disease is reviewed for the
purpose
of establishing a unified reporting system. The subject was debated and
reviewed
by members of the STS-Congenital Heart Surgery Database Committee and
representatives from the European Association for Cardiothoracic Surgery.
All
efforts were made to include all relevant nomenclature categories, using
synonyms where appropriate. Indications for lung transplantation are coded
under
a broad category called pulmonary failure. The proposed hierarchical scheme
also
allows classification of complications of lung transplantation under a
category
called status post lung transplant. A comprehensive database set is presented
which is based on a hierarchical scheme. Data are entered at various levels
of
complexity and detail, which can be determined by the clinician. These data
can
lay the foundation for comprehensive risk stratification analyses. A minimum
database set is also presented, which will allow for data sharing and would
lend
itself to basic interpretation of trends. Outcome tables relating diagnoses,
procedures, and various risk factors are presented.
Publication Types:
Review
Review, Tutorial
PMID: 10798440 [PubMed - indexed for MEDLINE]
128: Ann Thorac Surg. 2000 Apr;69(4 Suppl):S332-42.
Congenital Heart Surgery Nomenclature and Database Project: therapeutic
cardiac
catheter interventions.
Rocchini AP.
Division of Pediatric Cardiology, C. S. Mott Children's Hospital, University
of
Michigan Medical Center, Ann Arbor 48109-0204, USA. rocchini@umich.edu
The extant nomenclature for therapeutic cardiac catheter interventions is
reviewed for the purpose of establishing a unified reporting system. The
subject
was debated and reviewed by members of the STS-Congenital Heart Surgery
Database
Committee and representatives from the European Association for
Cardiothoracic
Surgery. All efforts were made to include all relevant nomenclature categories
using synonyms where appropriate. A comprehensive database set is presented
which is based on a hierarchical scheme. Data are entered at various levels
of
complexity and detail which can be determined by the clinician. These data
can
lay the foundation for comprehensive risk stratification analyses. A minimum
database set is also presented which will allow for data sharing and would
lend
itself to basic interpretation of trends. Outcome tables relating diagnoses,
procedures, and various risk factors are presented.
Publication Types:
Review
Review, Tutorial
PMID: 10798439 [PubMed - indexed for MEDLINE]
129: Ann Thorac Surg. 2000 Apr;69(4 Suppl):S319-31.
Congenital Heart Surgery Nomenclature and Database Project: arrhythmias.
Deal BJ, Jacobs JP, Mavroudis C.
Department of Pediatrics, Northwestern University Medical School, Children's
Memorial Hospital, Chicago, Illinois 60614, USA.
This discussion of arrhythmia terminology attempts to classify rhythm
disorders
for which surgical therapy may be necessary. The subject was debated and
reviewed by members of the STS-Congenital Heart Surgery Database Committee
and
representatives from the European Association for Cardiothoracic Surgery,
for
the purpose of establishing a unified reporting system. Efforts were made to
include all relevant nomenclature categories, using synonyms where
appropriate.
Extant surgical ablative procedures, detailed methods of pacemaker
insertion,
and AICD technology are discussed. A comprehensive database set is presented
that is based on a hierarchical scheme. Data are entered at various levels
of
complexity and detail, which can be determined by the clinician. These data
can
lay the foundation for comprehensive risk stratification analyses. A minimum
database set is also presented, which will allow for data sharing and will
lend
itself to basic interpretation of trends. Outcome tables relating diagnoses,
procedures, and various risk factors are presented.
Publication Types:
Review
Review, Tutorial
PMID: 10798438 [PubMed - indexed for MEDLINE]
130: Ann Thorac Surg. 2000 Apr;69(4 Suppl):S308-18.
Congenital Heart Surgery Nomenclature and Database Project: vascular rings,
tracheal stenosis, pectus excavatum.
Backer CL, Mavroudis C.
Department of Surgery, Northwestern University Medical School, Children's
Memorial Hospital, Chicago, Illinois 60614, USA. c-backer@nwu.edu
The extant nomenclature for vascular rings, tracheal stenosis, and pectus
deformities is reviewed for the purpose of establishing a unified reporting
system. The subject was debated and reviewed by members of the
STS-Congenital
Heart Surgery Database Committee and representatives from the European
Association for Cardiothoracic Surgery. All efforts were made to include all
relevant nomenclature categories using synonyms where appropriate. Vascular
rings are subclassified as double aortic arch, right arch/left ligamentum,
pulmonary artery sling, and innominate compression. Tracheal stenosis is
subclassified as congenital complete tracheal rings (localized or
long-segment)
or acquired postintubation types. Pectus deformities are subclassified as
pectus
excavatum and carinatum (mild, moderate, severe). A comprehensive database
set
is presented which is based on a hierarchical scheme. Data are entered at
various levels of complexity and detail which can be determined by the
clinician. These data can lay the foundation for comprehensive risk
stratification analyses. A minimum database set is also presented which will
allow for data sharing and would lend itself to basic interpretation of
trends.
Outcome tables relating diagnoses, procedures, and various risk factors are
presented.
Publication Types:
Review
Review, Tutorial
PMID: 10798437 [PubMed - indexed for MEDLINE]
131: Ann Thorac Surg. 2000 Apr;69(4 Suppl):S298-307.
Congenital Heart Surgery Nomenclature and Database Project: patent ductus
arteriosus, coarctation of the aorta, interrupted aortic arch.
Backer CL, Mavroudis C.
Department of Surgery, Northwestern University Medical School, Children's
Memorial Hospital, Chicago, Illinois 60614, USA. c-backer@nwu.edu
The extant nomenclature for patent ductus arteriosus (PDA), coarctation of
the
aorta (CoAo), and interrupted aortic arch (IAA) is reviewed for the purpose
of
establishing a unified reporting system. The subject was debated and
reviewed by
members of the STS-Congenital Heart Surgery Database Committee and
representatives from the European Association for Cardiothoracic Surgery.
All
efforts were made to include all relevant nomenclature categories using
synonyms
where appropriate. PDA is subclassified by origin, insertion, and patient
weight. CoAo is subclassified into isolated CoAo, CoAo with ventricular
septal
defect, and CoAo with complex intracardiac anomalies. IAA is subclassified
into
anatomic types A, B, and C based on the location of the interruption. A
comprehensive database set is presented which is based on a hierarchical
scheme.
Data are entered at various levels of complexity and detail which can be
determined by the clinician. These data can lay the foundation for
comprehensive
risk stratification analyses. A minimum database set is also presented which
will allow for data sharing and would lend itself to basic interpretation of
trends. Outcome tables relating diagnoses, procedures, and various risk
factors
are presented.
Publication Types:
Review
Review, Tutorial
PMID: 10798436 [PubMed - indexed for MEDLINE]
132: Ann Thorac Surg. 2000 Apr;69(4 Suppl):S270-97.
Congenital Heart Surgery Nomenclature and Database Project: anomalies of the
coronary arteries.
Dodge-Khatami A, Mavroudis C, Backer CL.
Northwestern University School of Medicine, Department of Surgery,
Children's
Memorial Hospital, Chicago, Illinois 60614, USA.
The extant nomenclature for coronary artery anomalies is reviewed for the
purpose of establishing a unified reporting system. The subject was debated
and
reviewed by members of the STS-Congenital Heart Surgery Database Committee
and
representatives from the European Association for Cardiothoracic Surgery.
All
efforts were made to include all relevant nomenclature categories using
synonyms
where appropriate. The seven major categories of coronary artery anomalies
are:
anomalous pulmonary artery origins of the coronaries, anomalous aortic
origins
of the coronaries, congenital atresia of the left main coronary artery,
coronary
artery fistulas, coronary artery bridging, coronary aneurysms, and coronary
stenosis. A comprehensive database set is presented which is based on a
hierarchical scheme. Data are entered at various levels of complexity and
detail, which can be determined by the clinician. These data can lay the
foundation for comprehensive risk stratification analyses. A minimum
database
set is also presented, which will allow for data sharing and would lend
itself
to basic interpretation of trends. Outcome tables relating diagnoses,
procedures, and various risk factors are presented.
Publication Types:
Review
Review, Tutorial
PMID: 10798435 [PubMed - indexed for MEDLINE]
133: Ann Thorac Surg. 2000 Apr;69(4 Suppl):S264-9.
Congenital Heart Surgery Nomenclature and Database Project: double outlet
left
ventricle.
Tchervenkov CI, Walters HL 3rd, Chu VF.
Division of Cardiovascular Surgery, The Montreal Children's Hospital,
Quebec,
Canada.
Double outlet left ventricle (DOLV) is a type of ventriculoarterial
connection
in which both great arteries arise entirely or predominantly from the left
ventricle. Although it was initially believed that bilateral absence of
conus is
a prerequisite for such diagnosis, all possible conal configurations have
been
described in this malformation. The morphology of DOLV is encompassed by a
careful description of the ventricular septal defect (VSD) with its
relationship
to the semilunar valves, the presence or absence of pulmonary outflow tract
obstruction (POTO) and aortic outflow tract obstruction (AOTO), and the
presence
or absence of associated cardiac lesions. The preferred surgical treatment
involves the connection of the right ventricle to the pulmonary circulation
by
an intraventricular tunnel repair connecting the VSD to the pulmonary
semilunar
valve. This ideal surgical therapy is not always possible, because of the
presence of confounding anatomical barriers. Several alternative surgical
procedures have been devised to accommodate these more complex situations. A
framework for the development of the DOLV module of a pediatric cardiac
surgical
database is proposed.
Publication Types:
Review
Review, Tutorial
PMID: 10798434 [PubMed - indexed for MEDLINE]
134: Ann Thorac Surg. 2000 Apr;69(4 Suppl):S249-63.
Congenital Heart Surgery Nomenclature and Database Project: double outlet
right
ventricle.
Walters HL 3rd, Mavroudis C, Tchervenkov CI, Jacobs JP, Lacour-Gayet F,
Jacobs
ML.
Department of Surgery, Wayne State University School of Medicine, Children's
Hospital of Michigan, Detroit 48201, USA. halwalters@aol.com
Double outlet right ventricle (DORV) is a type of ventriculoarterial
connection
in which both great vessels arise entirely or predominantly from the right
ventricle. Although the presence of aortic-mitral discontinuity and
bilateral
coni are important descriptors, they should not serve as absolute
prerequisites
for the diagnosis of DORV. The morphology of DORV is encompassed by a
careful
description of the ventricular septal defect (VSD) with its relationship to
the
semilunar valves, the great artery relationships to each other, the coronary
artery anatomy, the presence or absence of pulmonary outflow tract
obstruction
(POTO) and aortic outflow tract obstruction (AOTO), the tricuspid-pulmonary
annular distance, and the presence or absence of associated cardiac lesions.
The
preferred surgical treatment involves the connection of the left ventricle
to
the systemic circulation by an intraventricular tunnel repair connecting the
VSD
to the systemic semilunar valve. This ideal surgical therapy is not always
possible due to the presence of confounding anatomical barriers. A multitude
of
alternative surgical procedures has been devised to accommodate these more
complex situations. A framework for the development of the DORV module for a
pediatric cardiac surgical database is proposed.
Publication Types:
Review
Review, Tutorial
PMID: 10798433 [PubMed - indexed for MEDLINE]
135: Ann Thorac Surg. 2000 Apr;69(4 Suppl):S236-48.
Congenital Heart Surgery Nomenclature and Database Project: corrected
(discordant) transposition of the great arteries (and related
malformations).
Wilkinson JL, Cochrane AD, Karl TR.
Department of Cardiology, Royal Children's Hospital, Melbourne, Australia.
The extant nomenclature for congenitally corrected transposition of the
great
arteries is reviewed for the purpose of establishing a unified reporting
system.
The subject was debated and reviewed by members of the STS-Congenital Heart
Surgery Database Committee and representatives from the European Association
for
Cardiothoracic Surgery. All efforts were made to include all relevant
nomenclature categories using synonyms where appropriate. Congenitally
corrected
transposition of the great arteries is a complex cardiac lesion that is
associated with ventricular septal defect, left ventricular outflow tract
obstruction, and tricuspid valve abnormalities. Nomenclature for this lesion
has
been variable and confusing. Herein we attempt to clarify the terminology,
with
an emphasis on identification of synonymous and nonsynonymous appellations.
A
comprehensive database set is presented that is based on a hierarchical
scheme.
Data are entered at various levels of complexity and detail that can be
determined by the clinician. These data can lay the foundation for
comprehensive
risk stratification analyses. A minimum database set is also presented that
will
allow for data sharing and would lend itself to basic interpretation of
trends.
Outcome tables relating diagnoses, procedures, and various risk factors are
presented.
Publication Types:
Review
Review, Tutorial
PMID: 10798432 [PubMed - indexed for MEDLINE]
136: Ann Thorac Surg. 2000 Apr;69(4 Suppl):S205-35.
Congenital Heart Surgery Nomenclature and Database Project: transposition of
the
great arteries.
Jaggers JJ, Cameron DE, Herlong JR, Ungerleider RM.
Division of Cardiothoracic Surgery, Duke University Medical Center, Durham,
North Carolina 27710, USA. jagge003@mc.duke.edu
The extant nomenclature for transposition of the great arteries (TGA) is
reviewed for the purposes of establishing a unified reporting system. The
subject was debated and reviewed by members of the STS-Congenital Heart
Surgery
Database Committee and representatives from the European Association for
Cardiothoracic Surgery. All efforts were made to include relevant
nomenclature
categories including synonyms where appropriate. The general categories of
TGA
are: TGA with intact ventricular septum, TGA with ventricular septal defect
(VSD) and TGA with VSD and left ventricular outflow tract obstruction
(LVOTO). A
comprehensive database set is presented which is based on a hierarchical
scheme.
Data are entered at various levels of complexity and detail that can be
determined by the clinician. A detailed hierarchical system is described
herein
for classification of the coronary artery anatomy associated with TGA. These
data can lay the foundation for comprehensive risk stratification analyses.
A
minimum database set is also presented which will allow for data sharing and
would lend itself to basic interpretation of trends.
Publication Types:
Review
Review, Tutorial
PMID: 10798431 [PubMed - indexed for MEDLINE]
137: Ann Thorac Surg. 2000 Apr;69(4 Suppl):S197-204.
Congenital Heart Surgery Nomenclature and Database Project: single
ventricle.
Jacobs ML, Mayer JE Jr.
Section of Cardiothoracic Surgery, St. Christopher's Hospital for Children,
Philadelphia, Pennsylvania 19134-1095, USA.
The extant nomenclature for single ventricle (SV) hearts is reviewed for the
purpose of establishing a unified reporting system. The subject was debated
and
reviewed by members of the STS-Congenital Heart Surgery Database Committee
and
representatives from the European Association for Cardiothoracic Surgery.
Efforts were made to include all relevant nomenclature categories using
synonyms
where appropriate. Although many issues regarding single ventricle or
univentricular hearts remain unresolved among anatomists and pathologists, a
classification is proposed that is relevant to surgical therapy. A
comprehensive
database set is presented, which is based on a hierarchical scheme. Data are
entered at various levels of complexity and detail, which can be determined
by
the clinician. These data can lay the foundation for comprehensive risk
stratification analyses. A minimum data set is also presented that will
allow
for data sharing and would lend itself to basic interpretation of trends.
Outcome tables relating diagnoses, procedures, and various risk factors are
presented.
Publication Types:
Review
Review, Tutorial
PMID: 10798430 [PubMed - indexed for MEDLINE]
138: Ann Thorac Surg. 2000 Apr;69(4 Suppl):S191-6.
Congenital Heart Surgery Nomenclature and Database Project: diseases of the
pericardium.
Mehta SM, Myers JL.
Pediatric Cardiovascular Surgery, Children's Hospital, Milton S. Hershey
Medical
Center, Pennsylvania State University, Hershey 17033, USA.
The extant nomenclature for pericardial disease is reviewed for the purpose
of
establishing a unified reporting system. The subject was debated and
reviewed by
members of the STS-Congenital Heart Surgery Database Committee and
representatives from the European Association for Cardiothoracic Surgery.
All
efforts were made to include all relevant nomenclature categories, using
synonyms where appropriate. No classification system has been reported. The
groups were based on disease processes, and include: effusive pericarditis
(pericardial effusion), constrictive pericarditis, cardiac tamponade,
postoperative pericardial effusion, postoperative cardiac tamponade,
postpericardiotomy syndrome, congenital defect, neoplastic process, benign
mass,
pericardial cyst, pneumopericardium, and chylopericardium. A comprehensive
database set is presented that is based on a hierarchical scheme. Data are
entered at various levels of complexity and detail, which can be determined
by
the clinician. These data can lay the foundation for comprehensive risk
stratification analyses. A minimum database set is also presented that will
allow for data sharing and would lend itself to basic interpretation of
trends.
Publication Types:
Review
Review, Tutorial
PMID: 10798429 [PubMed - indexed for MEDLINE]
139: Ann Thorac Surg. 2000 Apr;69(4 Suppl):S180-90.
Congenital Heart Surgery Nomenclature and Database Project: pediatric
cardiomyopathies and end-stage congenital heart disease.
Delius RE.
Division of Cardiothoracic Surgery, University of California, Davis School
of
Medicine, Sacramento 95817, USA. ralph.delius@ucdmc.ucdavis.edu
The extant nomenclature for cardiomyopathy is reviewed for the purpose of
establishing a unified reporting system. The subject was debated and
reviewed by
members of the STS-Congenital Heart Surgery Database Committee and
representatives from the European Association for Cardiothoracic Surgery.
All
efforts were made to include all relevant nomenclature categories using
synonyms
where appropriate. A functional classification based on pathophysiology is
proposed. Cardiomyopathy is subdivided into: dilated cardiomyopathy,
hypertrophic cardiomyopathy, restrictive cardiomyopathy, right ventricular
cardiomyopathy, and end-stage congenital heart disease. A comprehensive
database
set is presented that is based on a hierarchical scheme. Data are entered at
various levels of complexity and detail that can be determined by the
clinician.
These data can lay the foundation for comprehensive risk stratification
analyses. A minimum database set is also presented that will allow for data
sharing and would lend itself to basic interpretation of trends. Outcome
tables
relating diagnoses, procedures, and various risk factors are presented.
Publication Types:
Review
Review, Tutorial
PMID: 10798428 [PubMed - indexed for MEDLINE]
140: Ann Thorac Surg. 2000 Apr;69(4 Suppl):S170-9.
Congenital Heart Surgery Nomenclature and Database Project: hypoplastic left
heart syndrome.
Tchervenkov CI, Jacobs ML, Tahta SA.
Division of Cardiovascular Surgery, The Montreal Children's Hospital, McGill
University, Quebec, Canada. ctchcvt@mch.mcgill.ca
Hypoplastic left heart syndrome (HLHS) encompasses a spectrum of structural
cardiac malformations that are characterized by severe underdevelopment of
the
structures in the left heart-aorta complex, including the left ventricular
cavity and mass. The severe end of the spectrum consists of aortic atresia
and
mitral atresia with a nonexistent left ventricle, whereas at the mild end
patients have aortic valve and mitral valve hypoplasia without intrinsic
valve
stenosis, and milder degrees of left ventricular hypoplasia, recently
described
as hypoplastic left heart complex (HLHC). Although the overwhelming majority
of
the patients can only have a univentricular repair, a small minority of
patients
with HLHS, particularly those that are described as having HLHC, may be
candidates for biventricular repair. In this paper, the extant nomenclature
for
HLHS is reviewed for the purpose of establishing a unified reporting system.
The
subject was debated and reviewed by members of the STS-Congenital Heart
Surgery
Nomenclature and Database Committee and representatives from the European
Association for Cardiothoracic Surgery. Efforts were made to include all
relevant nomenclature categories using synonyms where appropriate. A
comprehensive database set is presented, which is based on a hierarchical
scheme. Data are entered at various levels of complexity and detail that can
be
determined by the clinician. These data can lay the foundation for
comprehensive
risk stratification analyses. A minimum database set is also presented which
will allow for data sharing, and would lend itself to basic interpretation
of
trends. Outcome tables relating diagnoses, procedures, and various risk
factors
are presented.
Publication Types:
Review
Review, Tutorial
PMID: 10798427 [PubMed - indexed for MEDLINE]
141: Ann Thorac Surg. 2000 Apr;69(4 Suppl):S164-9.
Congenital Heart Surgery Nomenclature and Database Project: aortico-left
ventricular tunnel.
Myers JL, Mehta SM.
Pediatric Cardiovascular Surgery, Children's Hospital, Milton S. Hershey
Medical
Center, Pennsylvania State University, Hershey 17033, USA. jlmyers@psghs.edu
The extant nomenclature for aortico-left ventricular tunnel is reviewed for
the
purpose of establishing a unified reporting system. The subject was debated
and
reviewed by members of the STS-Congenital Heart Surgery Database Committee
and
representatives from the European Association for Cardiothoracic Surgery.
Efforts were made to include all relevant nomenclature categories using
synonyms
where appropriate. The Hovaguimian classification appears most useful to
surgeons: type 1, a simple tunnel with a slit-like opening at the aortic
end, no
aortic valve distortion; type II, a large extracardiac aortic wall aneurysm
of
the tunnel with an oval opening at the aortic end, with or without
ventricular
distortion; type III, intracardiac aneurysm of the septal portion of the
tunnel,
with or without right ventricular outflow tract obstruction; and type IV, a
combination of type II and III. A comprehensive database set is presented,
which
is based on a hierarchical scheme. Data are entered at various levels of
complexity and detail, which can be determined by the clinician. These data
can
lay the foundation for comprehensive risk stratification analyses. A minimum
database set is also presented which will allow for data sharing and would
lend
itself to basic interpretation of trends. Outcome tables relating diagnoses,
procedures, and various risk factors are presented.
Publication Types:
Review
Review, Tutorial
PMID: 10798426 [PubMed - indexed for MEDLINE]
142: Ann Thorac Surg. 2000 Apr;69(4 Suppl):S147-63.
Congenital Heart Surgery Nomenclature and Database Project: aortic aneurysm,
sinus of Valsalva aneurysm, and aortic dissection.
Ring WS.
Division of Thoracic and Cardiovascular Surgery, Children's Medical Center
of
Dallas, University of Texas Southwestern Medical Center, 75235-8879, USA.
sring@mednet.swmed.edu
The extant nomenclature for aortic aneurysms, sinus of valsalva aneurysms,
and
aortic dissections is reviewed for the purpose of establishing a unified
reporting system. The subject was debated and reviewed by members of the
STS-Congenital Heart Surgery Database Committee and representatives from the
European Association for Cardiothoracic Surgery. All efforts were made to
include all relevant nomenclature categories using synonyms where
appropriate.
Classification was based on morphology, histology, anatomic location,
etiology,
and acuity. A comprehensive database set is presented that is based on a
hierarchical scheme. Data are entered at various levels of complexity and
detail
that can be determined by the clinician. These data can lay the foundation
for
comprehensive risk stratification analyses. A minimum database set is also
presented that will allow for data sharing that would lend itself to basic
interpretation of trends. Outcome tables relating diagnoses, procedures, and
various risk factors are presented.
Publication Types:
Review
Review, Tutorial
PMID: 10798425 [PubMed - indexed for MEDLINE]
143: Ann Thorac Surg. 2000 Apr;69(4 Suppl):S132-46.
Congenital Heart Surgery Nomenclature and Database Project: mitral valve
disease.
Mitruka SN, Lamberti JJ.
Children's Heart Institute, San Diego Children's Hospital and Health Center,
California 92123, USA.
The extant nomenclature for mitral valve disease is reviewed for the purpose
of
establishing a unified reporting system. The subject was debated and
reviewed by
members of the STS-Congenital Heart Surgery Database Committee and
representatives from the European Association for Cardiothoracic Surgery.
All
efforts were made to include all relevant nomenclature categories using
synonyms
where appropriate. Mitral valve disease has been subdivided into stenotic
and
regurgitant lesions. Lesions have been characterized further by etiology and
by
anatomic location: supravalvar, valvar, and subvalvar. A comprehensive
database
set is presented which is based on a hierarchical scheme. Data are entered
at
various levels of complexity and detail which can be determined by the
clinician. These data can lay the foundation for comprehensive risk
stratification analyses. A minimum database set is also presented which will
allow for data sharing and would lend itself to basic interpretation of
trends.
Outcome tables relating diagnoses, procedures, and various risk factors are
presented.
Publication Types:
Review
Review, Tutorial
PMID: 10798424 [PubMed - indexed for MEDLINE]
144: Ann Thorac Surg. 2000 Apr;69(4 Suppl):S118-31.
Congenital Heart Surgery Nomenclature and Database Project: aortic valve
disease.
Nguyen KH.
Department of Cardiothoracic Surgery, Mount Sinai Medical Center, New York,
New
York 10029-6574, USA. khanhnguyen@mountsinai.org
The extant nomenclature for aortic valve disease is reviewed for the purpose
of
establishing a unified reporting system. The subject was debated and
reviewed by
members of the STS-Congenital Heart Surgery Database Committee and
representatives from the European Association for Cardiothoracic Surgery.
All
efforts were made to include all relevant nomenclature categories using
synonyms
where appropriate. Aortic valve disease has been subdivided into stenotic and
regurgitant lesions. Stenotic lesions have been characterized by anatomic
location: supravalvar, valvar, and subvalvar. Regurgitant lesions have been
characterized as either congenital or acquired. A comprehensive database set
is
presented that is based on a hierarchical scheme. Data are entered at
various
levels of complexity and detail that can be determined by the clinician.
These
data can lay the foundation for comprehensive risk stratification analyses.
A
minimum database set is also presented that will allow for data sharing and
would lend itself to basic interpretation of trends. Outcome tables relating
diagnoses, procedures, and various risk factors are presented.
Publication Types:
Review
Review, Tutorial
PMID: 10798423 [PubMed - indexed for MEDLINE]
145: Ann Thorac Surg. 2000 Apr;69(4 Suppl):S106-17.
Congenital Heart Surgery Nomenclature and Database Project: Ebstein's
anomaly
and tricuspid valve disease.
Dearani JA, Danielson GK.
Division of Cardiovascular and Thoracic Surgery, Mayo Clinic, Rochester,
Minnesota 55902, USA. jdearani@mayo.edu
Ebstein's anomaly is a rare congenital heart defect that is characterized by
a
spectrum of anatomical abnormalities of the tricuspid valve that also
involve
the right atrium and right ventricle. The extant nomenclature for Ebstein's
anomaly and our approach to the description of the severity of Ebstein's
anomaly
are reviewed with the objective of establishing a unified reporting system.
Although there are common features in Ebstein's anomaly, there is a wide
spectrum of pathology with an infinite variety of combinations of severity
of
the involved structures. An effort was made to develop a classification
system
that would take into consideration the anatomic abnormalities that help
direct
the surgical management, particularly in regard to tricuspid valve repair or
valve replacement. Isolated congenital tricuspid stenosis and regurgitation
are
also rare, and a simple classification system is presented. Acquired causes
of
tricuspid regurgitation and stenosis are more common and are included in the
classification system. A comprehensive database set for these malformations
is
presented so that a comprehensive risk stratification analysis can be performed.
A minimum database set is also presented that will allow for data sharing
and
would lend itself to basic interpretation of trends. Outcome tables relating
diagnoses, procedures, and risk factors are presented.
Publication Types:
Review
Review, Tutorial
PMID: 10798422 [PubMed - indexed for MEDLINE]
146: Ann Thorac Surg. 2000 Apr;69(4 Suppl):S97-105.
Comment in:
Ann Thorac Surg.
2001 Jul;72(1):316-7.
Congenital Heart Surgery Nomenclature and Database Project: pulmonary
atresia--ventricular septal defect.
Tchervenkov CI, Roy N.
Division of Cardiovascular Surgery, The Montreal Children's Hospital,
Quebec,
Canada.
Pulmonary atresia (PA) and ventricular septal defect (VSD) is a complex and
extremely heterogeneous cardiopulmonary malformation that has not been
accurately defined, as evidenced by the synonymous use of the term with
tetralogy of Fallot with PA. The anatomy and morphology of the pulmonary
circulation to a large extent determines the surgical approach and overall
outcome, with the intracardiac anatomy playing a secondary role. Based on
the
characterization of the pulmonary circulation a new classification of PA-VSD
is
proposed. In type A, there are only native pulmonary arteries (NPA). In type
B,
pulmonary blood flow is provided by both NPA and by major aortopulmonary
collateral arteries [MAPCA(s)]. In type C, there are only MAPCA(s) and no
NPA.
This new classification is proposed for the purpose of establishing a
unified
reporting system. The subject was debated and reviewed by members of the
STS-Congenital Heart Surgery Database Committee and representatives from the
European Association for Cardiothoracic Surgery. All efforts were made to
include all relevant nomenclature categories using synonyms where
appropriate. A
comprehensive database set is presented which is based on a hierarchical
scheme.
Data are entered at various levels of complexity and detail which can be
determined by the clinician. These data can lay the foundation for
comprehensive
risk stratification analyses. A minimum database set is also presented which
will allow for data sharing and would lend itself to basic interpretation of
trends. Outcome tables relating diagnoses, procedures, and various risk
factors
are presented.
Publication Types:
Review
Review, Tutorial
PMID: 10798421 [PubMed - indexed for MEDLINE]
147: Ann Thorac Surg. 2000 Apr;69(4 Suppl):S83-96.
Congenital Heart Surgery Nomenclature and Database Project: right
ventricular
outflow tract obstruction-intact ventricular septum.
Lacour-Gayet F.
Marie Lannelongue Hospital, Paris, France. flacourgayet@ccml.com
The extant nomenclature for pulmonary atresia/stenosis with intact
ventricular
septum, pulmonary artery and/or pulmonary branch stenosis, double chambered
right ventricle, absent pulmonary valve with intact ventricular septum, and
ventricular to pulmonary artery conduit failure is reviewed for the purpose
of
establishing a unified reporting system. The subject was debated and
reviewed by
members of the STS-Congenital Heart Surgery Database Committee and
representatives from the European Association for Cardiothoracic Surgery.
All
efforts were made to include all relevant nomenclature categories using
synonyms
where appropriate. Multiple risk factors were considered such as coronary
artery
fistulas/sinusoids, tricuspid annular size and location of peripheral
pulmonary
artery stenoses. A comprehensive database set is presented which is based on
a
hierarchical scheme. Data are entered at various levels of complexity and
detail
which can be determined by the clinician. These data can lay the foundation
for
comprehensive risk stratification analyses. A minimum database set is also
presented which will allow for data sharing and would lend itself to basic
interpretation of trends. Potential diagnostic related risk factors for each
lesion are presented.
Publication Types:
Review
Review, Tutorial
PMID: 10798420 [PubMed - indexed for MEDLINE]
148: Ann Thorac Surg. 2000 Apr;69(4 Suppl):S77-82.
Congenital Heart Surgery Nomenclature and Database Project: tetralogy of
Fallot.
Jacobs ML.
Section of Cardiothoracic Surgery, St. Christopher's Hospital for Children,
Philadelphia, Pennsylvania 19134-1095, USA.
The extant nomenclature for tetralogy of Fallot (TOF) is reviewed for the
purpose of establishing a unified reporting system. The subject was debated
and
reviewed by members of the STS-Congenital Heart Surgery Database Committee
and
representatives from the European Association for Cardiothoracic Surgery.
All
efforts were made to include all relevant nomenclature categories using
synonyms
where appropriate. The general categories of TOF are: classic TOF with varying
degrees of pulmonary stenosis, TOF with common atrioventricular canal
defect,
and TOF with absent pulmonary valve. Although centers may choose to code a
fourth general category, TOF with pulmonary atresia, this lesion will be
grouped
with pulmonary atresia-ventricular septal defect for multi-institutional
analysis. A comprehensive database set is presented that is based on a
hierarchical scheme. Data are entered at various levels of complexity and
detail
that can be determined by the clinician. These data can lay the foundation
for
comprehensive risk stratification analyses. A minimum database set is also
presented that will allow for data sharing and would lend itself to basic
interpretation of trends. Outcome tables relating diagnoses, procedures, and
various risk factors are presented.
Publication Types:
Review
Review, Tutorial
PMID: 10798419 [PubMed - indexed for MEDLINE]
149: Ann Thorac Surg. 2000 Apr;69(4 Suppl):S70-6.
Congenital Heart Surgery Nomenclature and Database Project: systemic venous
anomalies.
Gaynor JW, Weinberg PM, Spray TL.
Division of Pediatric Cardiothoracic Surgery, Cardiac Center at The
Children's
Hospital of Philadelphia, Pennsylvania 19104, USA. gaynor@email.chop.edu
The extant nomenclature for systemic venous anomalies is reviewed for the
purpose of establishing a unified reporting system. The subject was debated
and
reviewed by members of the STS-Congenital Heart Surgery Database Committee
and
representatives from the European Association for Cardiothoracic Surgery.
All
efforts were made to include all relevant nomenclature categories using
synonyms
where appropriate. This nomenclature system classifies systemic venous
anomalies
into two primary groups by venous segment: (1) systemic venous anomalies,
superior vena cava; and (2) systemic venous anomalies, inferior vena cava.
Subsets are clearly defined and categorized. A comprehensive database set is
presented that is based on a hierarchical scheme. Data are entered at
various
levels of complexity and detail that can be determined by the clinician.
These
data can lay the foundation for comprehensive risk stratification analyses.
A
minimum database set is also presented that will allow for data sharing and
would lend itself to basic interpretation of trends. Outcome tables relating
diagnoses, procedures, and various risk factors are presented.
Publication Types:
Review
Review, Tutorial
PMID: 10798418 [PubMed - indexed for MEDLINE]
150: Ann Thorac Surg. 2000 Apr;69(4 Suppl):S56-69.
Congenital Heart Surgery Nomenclature and Database Project: pulmonary venous
anomalies.
Herlong JR, Jaggers JJ, Ungerleider RM.
Division of Pediatric Cardiology, Duke University Medical Center, Durham,
North
Carolina 27710, USA.
The extant nomenclature for pulmonary venous anomalies is reviewed for the
purpose of establishing a unified reporting system. The subject was debated
and
reviewed by members of the STS-Congenital Heart Surgery Database Committee
and
representatives from the European Association for Cardiothoracic Surgery.
All
efforts were made to include all relevant nomenclature categories using
synonyms
where appropriate. The basis for classification are the prenatal errors of
embryologic development. The major categories include: partially anomalous
pulmonary venous connection, totally anomalous pulmonary venous connection,
atresia of the common pulmonary vein, cor triatriatum, and stenosis or
abnormal
number of pulmonary veins. A comprehensive database set is presented that is
based on a hierarchical scheme. Data are entered at various levels of
complexity
and detail that can be determined by the clinician. These data can lay the
foundation for comprehensive risk stratification analyses. A minimum
database
set is also presented that will allow for data sharing and would lend itself
to
basic interpretation of trends. Potential diagnostic-related risk factors
are
presented.
Publication Types:
Review
Review, Tutorial
PMID: 10798417 [PubMed - indexed for MEDLINE]
151: Ann Thorac Surg. 2000 Apr;69(4 Suppl):S50-5.
Congenital Heart Surgery Nomenclature and Database Project: truncus
arteriosus.
Jacobs ML.
Section of Cardiothoracic Surgery, St. Christopher's Hospital for Children,
Philadelphia, Pennsylvania 19134-1095, USA.
The extant nomenclature for truncus arteriosus (TA) is reviewed for the
purpose
of establishing a unified reporting system. The subject was debated and
reviewed
by members of the STS-Congenital Heart Surgery Database Committee and
representatives from the European Association for Cardiothoracic Surgery.
All
efforts were made to include all relevant nomenclature categories using
synonyms
where appropriate. A modified Van Praagh (VP) classification is proposed
involving three main categories of TA: TA with confluent or near confluent
pulmonary arteries (large aorta type, VP A1, A2), TA with absence of one
pulmonary artery (VP A3), and TA with interrupted aortic arch or coarctation
(large pulmonary artery type, VP A4). A comprehensive database set is
presented
that is based on a hierarchical scheme. Data are entered at various levels
of
complexity and detail that can be determined by the clinician. These data
can
lay the foundation for comprehensive risk stratification analyses. A minimum
database set is also presented that will allow for data sharing and would lend
itself to basic interpretation of trends. Outcome tables relating diagnoses,
procedures, and various risk factors are presented.
Publication Types:
Review
Review, Tutorial
PMID: 10798416 [PubMed - indexed for MEDLINE]
152: Ann Thorac Surg. 2000 Apr;69(4 Suppl):S44-9.
Congenital Heart Surgery Nomenclature and Database Project: aortopulmonary
window.
Jacobs JP, Quintessenza JA, Gaynor JW, Burke RP, Mavroudis C.
Division of Thoracic and Cardiovascular Surgery, All Children's Hospital,
University of South Florida School of Medicine, St. Petersburg 33701, USA.
jjacobs1@compuserve.com
The extant nomenclature for aortopulmonary window (AP window) and pulmonary
artery origin from ascending aorta (hemitruncus) is reviewed for the purpose
of
establishing a unified reporting system. The subject was debated and
reviewed by
members of the STS-Congenital Heart Surgery Database Committee and
representatives from the European Association for Cardiothoracic Surgery.
All
efforts were made to include all relevant nomenclature categories using
synonyms
where appropriate. A comprehensive database set is presented that is based
on a
hierarchical scheme. Data are entered at various levels of complexity and
detail
that can be determined by the clinician. These data can lay the foundation
for
comprehensive risk stratification analyses. A minimum database set is also
presented that will allow for data sharing and would lend itself to basic
interpretation of trends. Outcome tables relating diagnoses, procedures, and
various risk factors are presented.
Publication Types:
Review
Review, Tutorial
PMID: 10798415 [PubMed - indexed for MEDLINE]
153: Ann Thorac Surg. 2000 Apr;69(4 Suppl):S36-43.
Congenital Heart Surgery Nomenclature and Database Project: atrioventricular
canal defect.
Jacobs JP, Burke RP, Quintessenza JA, Mavroudis C.
Division of Thoracic and Cardiovascular Surgery, All Children's Hospital,
University of South Florida School of Medicine, St. Petersburg 33701, USA.
jjacobs1@compuserve.com
The extant nomenclature for atrioventricular (AV) canal/atrioventricular
septal
defect is reviewed for the purpose of establishing a unified reporting
system.
The subject was debated and reviewed by members of the STS-Congenital Heart
Surgery Database Committee and representatives from the European Association
for
Cardiothoracic Surgery. All efforts were made to include all relevant
nomenclature categories using synonyms where appropriate. The three general
categories are: partial AV canal (ostium primum defect), transitional
(intermediate) AV canal, and complete AV canal. A comprehensive database set
is
presented that is based on a hierarchical scheme. Data are entered at
various
levels of complexity and detail that can be determined by the clinician.
These
data can lay the foundation for comprehensive risk stratification analyses.
A
minimum database set is also presented that will allow for data sharing and
would lend itself to basic interpretation of trends. Outcome tables relating
diagnoses, procedures, and various risk factors are presented.
Publication Types:
Review
Review, Tutorial
PMID: 10798414 [PubMed - indexed for MEDLINE]
154: Ann Thorac Surg. 2000 Apr;69(4 Suppl):S25-35.
Congenital Heart Surgery Nomenclature and Database Project: ventricular
septal
defect.
Jacobs JP, Burke RP, Quintessenza JA, Mavroudis C.
Division of Thoracic and Cardiovascular Surgery, All Children's Hospital,
University of South Florida School of Medicine, St. Petersburg 33701, USA.
jjacobs1@compuserve.com
The extant nomenclature for ventricular septal defect (VSD) is reviewed for
the
purpose of establishing a unified reporting system. The subject was debated
and
reviewed by members of the STS-Congenital Heart Surgery Database Committee
and
representatives from the European Association for Cardiothoracic Surgery.
All
efforts were made to include all relevant nomenclature categories using
synonyms
where appropriate. Four basic VSD types are described: Subarterial,
Perimembranous, Inlet, and Muscular. A comprehensive database set is
presented
which is based on a hierarchical scheme. Data are entered at various levels
of
complexity and detail which can be determined by the clinician. These data
can
lay the foundation for comprehensive risk stratification analysis. A minimum
database set is also presented which will allow for data sharing and would
lend
itself to basic interpretation of trends. Outcome tables relating diagnoses,
procedures, and various risk factors are presented.
Publication Types:
Review
Review, Tutorial
PMID: 10798413 [PubMed - indexed for MEDLINE]
155: Ann Thorac Surg. 2000 Apr;69(4 Suppl):S18-24.
Congenital Heart Surgery Nomenclature and Database Project: atrial septal
defect.
Jacobs JP, Quintessenza JA, Burke RP, Mavroudis C.
Division of Thoracic and Cardiovascular Surgery, All Children's Hospital,
University of South Florida School of Medicine, St. Petersburg 33701, USA.
jjacobs1@compuserve.com
The extant nomenclature for atrial septal defect (ASD) is reviewed for the
purpose of establishing a unified reporting system. The subject was debated
and
reviewed by members of the STS-Congenital Heart Surgery Database Committee
and
representatives from the European Association for Cardiothoracic Surgery.
All
efforts were made to include all relevant nomenclature categories using
synonyms
where appropriate. A comprehensive database set is presented that is based
on a
hierarchical scheme. Data are entered at various levels of complexity and
detail
that can be determined by the clinician. These data can lay the foundation
for
comprehensive risk stratification analyses. A minimum database set is also
presented that will allow for data sharing and would lend itself to basic
interpretation of trends. Outcome tables relating diagnoses, procedures, and
various risk factors are presented.
Publication Types:
Review
Review, Tutorial
PMID: 10798412 [PubMed - indexed for MEDLINE]
156: Paediatr Anaesth. 2000;10(3):237-51.
Review article: anaesthesia for thoracic surgery in children.
Haynes SR, Bonner S.
Department of Cardiothoracic Anaesthesia, Freeman Hospital, Newcastle upon
Tyne,
NE7 7DN, UK.
Publication Types:
Review
Review, Tutorial
PMID: 10792739 [PubMed - indexed for MEDLINE]
157: Respir Care. 2000 Apr;45(4):411-6.
Persistent left superior vena cava: case report and literature review.
Sarodia BD, Stoller JK.
Department of Pulmonary and Critical Care Medicine, Cleveland Clinic
Foundation,
Ohio 44195, USA.
A persistent left superior vena cava (PLSVC) is the most common thoracic
venous
anomaly. It is a persistent remnant of a vessel that is present as a
counterpart
of normal right-sided superior vena cava (SVC) in early embryological
development but normally disappears later. Although it can be easily
diagnosed
by the characteristic chest radiographic appearance of a pulmonary artery
catheter (PAC) passed through it after being inserted into the left
subclavian
or jugular vein, its diagnosis is usually missed by the presence of normal
(right) SVC and the passage of the catheter on the right side. Its diagnosis
can
be confirmed by many noninvasive and invasive tests, or it is incidentally
diagnosed at thoracic surgery or autopsy. If it is not associated with other
congenital cardiac anomalies, it is usually asymptomatic and hemodynamically
insignificant. However, PLSVC has important clinical implications in certain
situations. In this article, we describe a patient with bilateral SVC (a
normal
right SVC and a PLSVC) identified by a PAC in the PLSVC and the pacemaker
wires
in the right SVC. In addition, we review the literature on prevalence,
embryological development, diagnosis, and clinical implications of PLSVC.
Publication Types:
Case Reports
Review
Review of Reported
Cases
PMID: 10780037 [PubMed - indexed for MEDLINE]
158: Curr Probl Surg. 2000 Apr;37(4):253-317.
Lung volume reduction surgery.
Shrager JB, Kaiser LR, Edelman JD.
University of Pennsylvania School of Medicine, Philadelphia, USA.
Publication Types:
Historical Article
Review
Review, Tutorial
PMID: 10778395 [PubMed - indexed for MEDLINE]
159: Eur Spine J. 2000 Feb;9 Suppl 1:S8-16.
Endoscopic approaches to the thoracic spine.
Rosenthal D.
Neurochirurgische Praxisgemeinschaft, und Kliniken des Hochtaunuskreises,
Bad
Homburg v.d. Hoehe, Germany. Trosen@aol.com
Endoscopic surgery of the thoracic spine has up to now been considered as an
experimental procedure. Reports published in recent years have shown that
the
results achieved with this technique are as good as, or for some indications
superior to, those reported for classic open approaches. A review of the
indications, limitations, advantages and disadvantages is presented.
Although
there is still resistance to acknowledging the effectiveness of this
procedure,
experience has shown that the results are as good, complications are fewer
and
postoperative recovery is improved, thus shortening the total
hospitalization
time.
Publication Types:
Review
Review, Tutorial
PMID: 10766052 [PubMed - indexed for MEDLINE]
160: Clin Chest Med. 2000 Mar;21(1):95-106, viii-ix.
Diagnosis and staging of lung cancer.
Hyer JD, Silvestri G.
Division of Pulmonary and Critical Care Medicine, Allergy, and Clinical
Immunology, Medical University of South Carolina, Charleston, USA.
Lung cancer is the biggest cancer killer among men and women in the United
States. Lung cancer can present in a myriad of ways and the goal of prompt
diagnosis and staging requires that the clinician be able to knowledgeably
choose from a variety of tools available for such purpose. Review of some of
these tools and general strategies with regard to staging is provided. Many
new
technologies are becoming available and much evaluation needs to be done
before
their proper roles become well defined. Little has changed with regard to
staging of small cell lung cancer in recent years. The International System
for
Staging Non-Small-Cell Lung Cancer was revised for a second time in 1997.
Although the revisions have largely corrected the shortcomings of the 1985
version, some controversies persist. Whenever possible, a multidisciplinary
approach to diagnosis, staging, and therapy should be utilized. This should
include incorporating the services of the pulmonologist, the thoracic
surgeon,
the medical oncologist, the radiologist, the radiation therapist, the
pathologist, the respiratory therapist, and the social worker.
Publication Types:
Review
Review, Tutorial
PMID: 10763092 [PubMed - indexed for MEDLINE]
161: J Thorac Cardiovasc Surg. 2000 Apr;119(4 Pt 2):S26-8.
Getting funded.
Kron IL.
Department of Surgery, Division of Thoracic and Cardiovascular Surgery,
University of Virginia Health Sciences Center, Charlottesville, VA 22908,
USA.
ikron@virginia.edu
Getting funded is still possible for cardiothoracic surgeons. You must have
a
clear hypothesis, have an organized approach, and develop excellent
preliminary
data. Most important, you need to apply to get funded.
Publication Types:
Review
Review, Tutorial
PMID: 10727958 [PubMed - indexed for MEDLINE]
162: Int Anesthesiol Clin. 2000 Winter;38(1):1-23.
Anesthetic considerations for patients with severe emphysematous lung
disease.
Seigne PW, Hartigan PM, Body SC.
Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and
Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
The pathophysiology, medical and surgical management of emphysema have been
reviewed as a foundation to the physiological goals and principles of
anesthetic
management of patients with emphysema. An understanding of the cardiovascular
and respiratory consequences of emphysema combined with anesthesia, PPV, and
thoracic surgery is essential to achieving the challenging physiological
goals
of providing anesthesia, positive pressure and one-lung ventilation, and
postoperative analgesia in a manner consistent with rapid postoperative
extubation, hemodynamic stability, adequate gas exchange, and minimal
barotrauma
for this population of patients.
Publication Types:
Review
Review, Tutorial
PMID: 10723667 [PubMed - indexed for MEDLINE]
163: Hosp Med. 1999 Nov;60(11):807-11.
Current practice in thoracic sympathectomy.
Chaudhuri N, Birdi I, Ritchie AJ.
Department of Cardiothoracic Surgery, Papworth Hospital.
Thoracic sympathectomy has been performed for many years. With the recent
development of video assisted thoracic surgical techniques the indications
for
surgery have increased, and the outcome is much better.
Publication Types:
Review
Review, Tutorial
PMID: 10707191 [PubMed - indexed for MEDLINE]
164: Chest Surg Clin N Am. 2000 Feb;10(1):105-30, ix.
The history of lobectomy and segmentectomy including sleeve resection.
Kittle CF.
Department of Cardiovascular and Thoracic Surgery, Rush Medical College,
Rush
University, Chicago, Illinois, USA. KITTLE856@aol.com
The evolution of pulmonary lobectomy during the past six centuries is
presented.
The anesthetic problems of an open thorax, the absence of antibiotics, and
the
absence of radiology initially complicated thoracic surgery. Surgical
pioneers
differed strongly on the best techniques for lobectomy. Concurrence in their
opinions evolved by the formation of a specialty group, meetings, and
journals.
The recent techniques of segmentectomy and sleeve resection provide further
refinement of pulmonary resections.
Publication Types:
Historical Article
Review
Review, Academic
PMID: 10689530 [PubMed - indexed for MEDLINE]
165: Chest Surg Clin N Am. 2000 Feb;10(1):9-43.
The history of thoracic surgical instruments and instrumentation.
Hagopian EJ, Mann C, Galibert LA, Steichen FM.
Department of Surgery, St. Agnes Hospital, White Plains, New York, USA.
Thoracic surgical practice has evolved from the innovations of its pioneers.
Beginning with the stethoscope discovered by Laennec with his system of
auscultation, to the tools we use in the dissection and control of the hilum
of
the lung for resection, our practice of thoracic surgery has been entwined
with
the development of instruments and instrumentation. The development of
strategies to prevent death from the open pneumothorax began with manual
control
of the mediastinum and progressed through differential pressure to, finally,
the
technique of intubation and the methods of positive-pressure and
insufflation
anesthesia. The instruments we place in our hands are not enough to define
our
art. Entry into the chest would not be possible without the use of rib
retractors, rib shears, and even periosteal elevators. Finally, to the
present
day of minimally invasive techniques and the application of thoracoscopy for
therapeutic purposes, we find the efforts of our predecessors well
developed.
For the progression from the fear of the open pneumothorax to the
present-day
state of the ease of thoracotomy for lung resection we are indebted to those
who
gave so much of their time and, for some, their lives to death from
tuberculosis, to allow the advancement of our practice of surgery. These
great
people should be remembered not only for their acceptance of novel ideas but
also, more importantly, for their lack of fear of testing them.
Publication Types:
Historical Article
Review
Review, Tutorial
PMID: 10689525 [PubMed - indexed for MEDLINE]
166: J Am Coll Surg. 2000 Feb;190(2):152-65.
General thoracic surgery.
Kaiser LR.
Department of Surgery, University of Pennsylvania School of Medicine,
Hospital
of the University of Pennsylvania, Philadelphia 19104, USA.
Publication Types:
Review
Review, Tutorial
PMID: 10656551 [PubMed - indexed for MEDLINE]
167: Chest. 1999 Dec;116(6 Suppl):519S-522S.
Role of radiology for imaging and biopsy of solitary pulmonary nodules.
Shaffer K.
Dana-Farber Cancer Institute, Boston, MA 02115, USA.
kitt_shaffer@dfci.harvard.edu
Both imaging and image-directed biopsy play a major role in evaluating
solitary
pulmonary nodules. Imaging is used to determine whether the nodule is
actually
solitary or if multiple nodules are present. Once a nodule has been
detected,
imaging techniques can be used to characterize the nodule in terms of
whether it
is likely benign or malignant. As technology has improved, smaller nodules
are
now more easily detected, which may create a management dilemma. With the
advent
of video-assisted thoracoscopic techniques, however, sampling of these
lesions
has become much easier. Once a solitary pulmonary nodule is detected,
image-guided biopsy is often considered, which can be undertaken using CT or
fluoroscopy. Technical limitations, the location of the solitary pulmonary
nodules, and clinical conditions must be considered when determining the
role of
image-guided biopsy. Other concerns include the role of on-site cytology and
the
use of more recent technical advances. Image-guided biopsy should be used as
part of a multimodality approach to patient management, and decisions should
be
discussed with the radiologist and other caregivers to determine the
cost-effectiveness and safety of the procedure for each patient.
Publication Types:
Review
Review, Tutorial
PMID: 10619523 [PubMed - indexed for MEDLINE]
168: Eur J Cardiothorac Surg. 1999 Nov;16 Suppl 2:S119-25.
Is there a future for minimally invasive cardiac surgery?
Mack MJ.
Cardiopulmonary Research Science And Technology Institute, Dallas, TX 75230,
USA.
Although cardiac surgery has made significant contributions to the cardiac
health of millions of patients over the past 40 years, it has evolved from
an
'emerging growth' to a 'mature' industry. Along with this maturation has
come an
'inertia of success' and lack of innovation. Minimally invasive cardiac
surgery
is an attempt to develop more patient friendly cardiac procedures yet
maintain
the superior long term results of conventional cardiac surgery. A broad
spectrum
of new surgical techniques and technical innovations has been fostered. The
impact has been not only that of 'discontinuous innovation' of a new type of
cardiac surgery but also a significant 'coat-tail' effect of 'upgrading'
conventional cardiac surgery. It is difficult to adapt to change. But if we
maintain an open-mindedness toward evolution with a firm foundation in
proven
standards, our patients will be the beneficiaries.
Publication Types:
Review
Review, Tutorial
PMID: 10613572 [PubMed - indexed for MEDLINE]
169: Eur J Cardiothorac Surg. 1999 Nov;16 Suppl 2:S106-11.
ARTEMIS. A telemanipulator for cardiac surgery.
Rininsland H.
Karlsruhe Research Centre, Central Engineering Department,
(Forschungszentrum
Karlsruhe Technik und Umwelt, Hauptabteilung Ingenieurtechnik), Germany.
hafi@hit.fzk.de
ARTEMIS, the Advanced Robotics and TElemanipulator System for Minimally Invasive
Surgery, is designed as an integrated teleoperation and telepresence system
for
planning, training and performing different minimally invasive surgical
procedures. The actual prototype was developed as an experimental device for
exploring and testing the needed technologies and their capability and
quality
with respect to surgical application. The main components are two
master-slave
units guiding the surgical instruments and a remotely controlled endoscope
guiding system. Each master-slave device consists of the slave or work unit
and
the master or control unit which are interconnected by a computer based
control
system. The work unit is operating at the patient by means of dexterous
surgical
instruments consisting of multifunctional endoeffectors with flexible distal
section providing six degrees of freedom. The kinematic structure of the
work
unit ensures a precise motion around the incision point through the
abdominal or
thoracic wall. The master or control unit guided by the surgeon is designed
to
enable the surgeon to operate intuitively as if he were guiding the tip of
the
endoeffector manually. The powered endoscope guiding system is equipped with
a
3D-endoscope. The computer based control system interconnecting control and
work
units has an open system architecture which allows to couple differently
designed masters and slaves, monitoring systems, graphical system and user
interfaces. The endoscope can be guided by a simple joystick, voice control
or
automatic camera tracking. For minimally invasive cardiac surgery a new
concept
has to be developed. In co-operation with the Cardiovascular Institute of
the
University of Dresden a step-by-step procedure was agreed. The
state-of-the-art
is described.
Publication Types:
Review
Review, Tutorial
PMID: 10613569 [PubMed - indexed for MEDLINE]
170: Eur J Cardiothorac Surg. 1999 Nov;16 Suppl 2:S93-6.
Tools for precision enhancement in minimally invasive cardiac surgery: three
dimensional visualization, computer enhancement and robotics.
Shennib H.
Division of Cardiothoracic Surgery, McGill University, The Montreal General
Hospital, Quebec, Canada.
This article is a current update of the rationale for development of new
enabling technologies in minimally invasive cardiac surgery. Specifically
the
potential advantages of three dimensional visualization, computer
enhancement
technology and robotics in performance of totally endoscopic coronary artery
bypass grafts will be addressed.
Publication Types:
Review
Review, Tutorial
PMID: 10613567 [PubMed - indexed for MEDLINE]
171: Eur J Cardiothorac Surg. 1999 Sep;16(3):283-6.
Videothoracoscopic debridement of the postpneumonectomy space in empyema.
Hollaus PH, Lax F, Wurnig PN, Janakiev D, Pridun NS.
Department of Thoracic Surgery, Pulmologisches Zentrum Vienna, Austria.
peter.hollaus@pul.magwien.gv.at
OBJECTIVE: Simple irrigation has proven to be an efficient method to treat
postpneumonectomy empyema provided that bronchopleural fistula is not
present or
successfully closed. However, with this treatment modality, infected
material
inside the thoracic cavity is not removed and this can be a potential source
of
empyema recurrence if the patient's immune system is compromised. The
removal of
the infected material should result in a lower recurrence rate. METHODS: As
soon
as diagnosis of postpneumonectomy empyema was established, a chest tube
drainage
was inserted. A concomitant bronchopleural fistula was evaluated
bronchoscopically. If the fistula was smaller than 3 mm, bronchoscopic
sealing
with fibrin glue (Tissucol, Immuno, Vienna) was initiated. Fistulas closed
surgically were excluded from this analysis. The thoracic cavity was cleared
of
infected material by videothoracoscopy and bacteriological samples were
taken.
Immediately after operation antibiotic irrigation according to culture
sensitivity was started via a single chest tube drainage twice a day. After
instillation of antibiotics the drain was kept clamped for 3 h. Culture
samples
were obtained twice a week. Empyema was considered eradicated, if three
subsequent cultures showed no bacterial growth. After drain removal the
patients
were kept in hospital for another week and observed for clinical signs of
infection; WBC and CRP were controlled. RESULTS: Nine patients (five men,
four
women) between 55 and 72 years (mean 61, SD 6), all initially operated on
for
malignancy, were successfully treated with this regimen. In three cases a
concomitant bronchopleural fistula was successfully closed before
videothoracoscopy. The interval between primary operation and empyema was
between 7 and 436 days (mean 93, SD 141). There was no postoperative
mortality
and no procedure related morbidity. Operating time ranged from 45 to 165 min
(mean 92.7, SD 36.6), the suction volume (consisting of blood, debris and
pus)
was 300 to 1000 ml (mean 880, SD 600). Duration of thoracic drainage was
12-38
days (mean 22, SD 9), duration of hospital stay after videothoracoscopy
21-46
days (mean 29, SD 9). During the follow-up period of 204-1163 days (mean
645, SD
407) no recurrence of tumour or empyema was observed. CONCLUSIONS:
Videothoracoscopic debridement of the postpneumonectomy space with
postoperative
antibiotic irrigation of the pleural space is an efficient method to treat
postpneumonectomy empyema, provided that a concomitant bronchopleural
fistula
can be closed successfully. No early empyema or fistula recurrence were
observed. However, late recurrence may occur many years after operation,
therefore close follow-up is indicated.
Publication Types:
Review
Review, Tutorial
PMID: 10554844 [PubMed - indexed for MEDLINE]
172: Eur J Cardiothorac Surg. 1999 Sep;16 Suppl 1:S57-60.
Surgical strategy for lung volume reduction surgery.
Hazelrigg SR, Boley TM, Grasch A, Shawgo T.
Southern Illinois University, School of Medicine, Cardiothoracic Surgery,
Springfield 62794-9638, USA. shazelrigg@siumed.edu
Lung volume reduction surgery (LVRS) has been a popular procedure since the
early 1990s. It appears that there has developed a consensus in the
literature
that the ideal patient is one with evidence of marked hyperinflation and
heterogenous disease. In this patient profile, LVRS has produced excellent
results with respect to lung function and improved exercise tolerance.
General
areas of controversy are discussed which include the role of lasers;
unilateral
versus bilateral procedures; the role of a staged unilateral procedure; and
which surgical route is best for patients. The existing literature is
reviewed
on these issues.
Publication Types:
Review
Review, Tutorial
PMID: 10536949 [PubMed - indexed for MEDLINE]
173: Eur J Cardiothorac Surg. 1999 Sep;16 Suppl 1:S13-5; discussion
S15-6.
Pulmonary metastases: biologic and historical justification for VATS. Video
assisted thoracic surgery.
Sonett JR.
Publication Types:
Editorial
Review
Review, Tutorial
PMID: 10536939 [PubMed - indexed for MEDLINE]
174: Semin Thorac Cardiovasc Surg. 1999 Oct;11(4):358-62.
Treatment of epiphrenic diverticula.
Allen MS.
Mayo Medical Center, Rochester, MN, USA.
Epiphrenic diverticulum is a rare disorder of the lower esophagus, thought
to be
related to an esophageal motility disorder. Treatment should involve removal
of
diverticulum and myotomy. Although the surgery is technically a difficult
one,
the long-term outcome should be excellent.
Publication Types:
Review
Review, Tutorial
PMID: 10535377 [PubMed - indexed for MEDLINE]
175: Postgrad Med. 1999 Oct 1;106(4):139-44, 146,150 passim.
Thoracoscopic lung biopsy. Five commonly asked questions about video-assisted
thoracic surgery.
Shrager JB, Kaiser LR.
Department of Surgery, University of Pennsylvania School of Medicine,
Philadelphia 19104-4283, USA. jshrag@mail.med.upenn.edu
VATS has proved to be an extremely useful diagnostic tool. Perhaps its most
frequent application has been in lung biopsy to diagnose indeterminate
solitary
pulmonary nodules and interstitial infiltrates. In many institutions, VATS
procedures have largely replaced previous methods of attempting to establish
the
nature of a solitary pulmonary nodule. In ambulatory patients with
indeterminate
infiltrates, VATS techniques have prompted earlier referral to establish a
tissue diagnosis, with apparently decreased morbidity. VATS has clearly
found a
place in the modern practice of thoracic surgery and is likely to play an
ever-increasing role in the management of diseases of the chest.
Publication Types:
Review
Review, Tutorial
PMID: 10533514 [PubMed - indexed for MEDLINE]
176: Crit Rev Oncol Hematol. 1999 Jun;31(1):27-30.
Pro and contra in minimally invasive oncological surgery. Minimally invasive
surgery in lung cancer.
Mezzetti M, Panigalli T, Crosta C, Cappelli R, Fumagalli F, Peta D, Lo
Giudice
F.
Cattedra di Chirurgia Toracica, Universita degli Studi di Milano-Direttore
Clinica Chirurgica, Ospedale San Paolo, Italy.
Publication Types:
Review
Review, Tutorial
PMID: 10532188 [PubMed - indexed for MEDLINE]
177: World J Surg. 1999 Nov;23(11):1148-55.
Current status of thoracoscopic lung volume reduction.
Krucylak PE, Keller CA, Naunheim KS.
Department of Anesthesiology, Saint Louis University Health Sciences Center,
3635 Vista Avenue at Grand Boulevard, PO Box 15250, St. Louis, Missouri
63110-0250, USA.
Surgical therapy has recently been reintroduced for the treatment of
emphysema,
and a number of investigators have used video-assisted thoracic surgical
(VATS)
techniques to accomplish lung volume reduction. The published reports differ
with regard to patient selection, preoperative preparation, operative
approach,
and surgical technique. The results of these reports are reviewed and
compared.
Thoracoscopic lung volume reduction appears to be a useful part of the
surgeon's
armamentarium in managing patients with severe pulmonary emphysema.
Publication Types:
Review
Review, Tutorial
PMID: 10501877 [PubMed - indexed for MEDLINE]
178: Curr Opin Pulm Med. 1999 Sep;5(5):284-6.
The role of thoracic surgery in diagnosing interstitial lung disease.
Rizzato G.
Sarcoidosis Clinic, Niguarda Hospital, Milan, Italy.
In this article, the current status of thoracic surgery options for reaching
a
diagnosis in interstitial lung disease is described. When surgery is needed,
mediastinoscopy is the first step in cases of suspected stage I or II
sarcoidosis. If this is not the case, video-assisted thoracoscopy is
currently
preferred to open lung biopsy because the need for analgesia lessened, less
blood is lost, the operative time is shorter, the complication rate is
lower,
and the postoperative stay is shorter. In some cases, video-assisted
thoracoscopy may also be preferred to mediastinoscopy, especially in young
women, for cosmetic reasons.
Publication Types:
Review
Review, Tutorial
PMID: 10461531 [PubMed - indexed for MEDLINE]
179: Chest Surg Clin N Am. 1999 Aug;9(3):543-64, viii.
Early complications. Respiratory failure.
Zwischenberger JB, Alpard SK, Bidani A.
Division of Cardiothoracic Surgery, University of Texas Medical Branch,
Galveston, USA. jzwische@utmb.edu
Pulmonary complications following thoracic surgery are common and associated
with significant morbidity and mortality. Respiratory failure after
pneumonectomy occurs in approximately 5% to 15% of cases and significantly
increases patient mortality. Strategies for ventilator support are based on
the
nature of the underlying complication and the pathophysiology of respiratory
failure. This article describes the cause and pathophysiology of respiratory
failure and pulmonary embolus postpneumonectomy. Diagnosis, management, and
innovative therapies are also reviewed.
Publication Types:
Review
Review, Tutorial
PMID: 10459429 [PubMed - indexed for MEDLINE]
180: Acta Chir Belg. 1999 May-Jun;99(3):103-8.
Role of video-assisted thoracic surgery (VATS) in staging, diagnosis and
treatment of lung cancer.
Van Schil P.
Department of Surgery, University Hospital of Antwerp, Edegem, Belgium.
paul.van.schil@uza.uia.ac.be
VATS, video-assisted thoracic surgery, is presently used for a variety of
thoracic disorders and represents a new approach to thoracic disease. It
plays a
specific role in staging, diagnosis and treatment of lung cancer. For precise
mediastinal lymph node staging, cervical mediastinoscopy remains the gold
standard. VATS can replace anterior mediastinoscopy and is useful to take
biopsies of lymph nodes not accessible by cervical mediastinoscopy and to
judge
resectability of the primary tumour. Precise diagnosis of solitary pulmonary
nodules is possible by VATS but protective measures should be taken to
prevent
spillage of tumour cells. Positron emission tomography has recently proven
to be
valuable in staging and diagnosis of lung cancer but its precise role
remains to
be determined. VATS is presently not advocated for definite treatment of
lung
cancer. The only possible exceptions are peripheral T1N0 squamous cell
carcinomas smaller than 2 cm., but resections less than lobectomy are
oncologically not adequate.
Publication Types:
Review
Review, Tutorial
PMID: 10427343 [PubMed - indexed for MEDLINE]
181: Curr Opin Pulm Med. 1999 Jul;5(4):256-8.
Thoracoscopy and video-assisted thoracic surgery.
Yim AP.
Department of Surgery, Chinese University of Hong Kong, Prince of Wales
Hospital, China. yimap@cuhk.edu.hk
Thoracoscopy is an old technique that has been recently revived with the
development of video-endoscopic technology. Video-assisted thoracic surgery
(VATS) is now an established surgical approach with proven benefits in the
management of pleural diseases. It has been found to be particularly useful
in
establishing the diagnosis of pleural metastasis with an option for
treatment.
It also has an established therapeutic role in the management of the
fibrinopurulent phase of empyema and the treatment of hemothorax. The
technique
is still continually evolving, and refinement of instrumentation promises to
further reduce surgical trauma in selected procedures.
Publication Types:
Review
Review, Tutorial
PMID: 10407697 [PubMed - indexed for MEDLINE]
182: Chest Surg Clin N Am. 1999 May;9(2):419-36, xi-xii.
Techniques of pneumonectomy. Video-assisted thoracic surgery pneumonectomy.
Roviaro G, Varoli F, Vergani C, Maciocco M.
Department of General Surgery, University of Milan, Italy.
Thoracoscopic major pulmonary resections such as lobectomies or
pneumonectomies
are the most difficult operations that can be attempted thoracoscopically,
and
still have limited routine application in thoracic surgical practice. The
precise indications for thoracoscopic pneumonectomy are very rare and have
not
yet been defined precisely; we limited the procedure only to double tumors,
small tumors infiltrating the fissure, and small tumors at the secondary
carina
not amenable to a bronchoplasty procedure. Although the technique still has
very
limited applications, the advantages include reduced surgical trauma and
consequent minimal postoperative pain, a shortened hospital stay, and a
rapid
resumption of normal activities which ultimately reduces costs. Wider
acceptance, larger series, and a more extensive follow-up will assess the
role
of thoracoscopic anatomical lung resection in modern thoracic surgical
practice.
Publication Types:
Review
Review, Tutorial
PMID: 10365273 [PubMed - indexed for MEDLINE]
183: Anesth Analg. 1999 Jun;88(6):1272-9.
Comment in:
Anesth Analg. 1999
Dec;89(6):1592.
Pulmonary function after cardiac and thoracic surgery.
Weissman C.
Department of Anesthesiology and Critical Care Medicine, Hadassah-Hebrew
University School of Medicine, Jerusalem, Israel. Charles@hadassah.org.il
Publication Types:
Review
Review, Tutorial
PMID: 10357329 [PubMed - indexed for MEDLINE]
184: Respirology. 1999 Mar;4(1):19-29.
Thoracoscopic procedures for intrathoracic and pulmonary diseases.
Sung SW, Kim JS.
Seoul National University Hospital, Korea. swsung@snu.ac.kr
Since Jacobaeus performed the first thoracoscopy to explore pleural space
and
mechanically broke pleural adhesions to facilitate the collapse therapy for
pulmonary tuberculosis in 1910, numerous thoracic surgeons have been
attempting
this technique as a means of accomplishing many intrathoracic procedures
previously done through open thoracotomy. As the refinement of video
technology
has advanced, thoracoscopic surgery has played a very important role in
thoracic
surgery especially since the early 1990s. Because the advantages of
video-assisted thoracoscopic surgery for patients include low
post-thoracotomy-related morbidity, cosmetic considerations, low pain,
earlier
post-operative mobilization, and a shorter operation time in some
indications,
surgeons have been demonstrating its increasing utility in the diagnosis and
treatment of the pleura, lung, mediastinum, great vessels, pericardium, and
oesophagus. The most common application of the thoracoscopic approach still
remains in the management of pleuropulmonary disease. The indications for
the
thoracoscopic technique are very broad, but its role in the management of
primary lung and oesophageal cancer has yet to be confirmed. Thus, the
surgeon
who uses the technique in these cancerous diseases should be prudent. In
conclusion, these thoracoscopic procedures will play more important roles in
the
practice of thoracic surgery in the future.
Publication Types:
Review
Review, Tutorial
PMID: 10339727 [PubMed - indexed for MEDLINE]
185: Respirology. 1999 Mar;4(1):9-17.
Thoracoscopic procedures for intrathoracic diseases: the present status.
Asamura H.
Division of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan.
hasamura@gan2.ncc.go.jp
Thoracoscopic operations, alternatively termed as video-assisted thoracic
surgery (VATS), are replacing the variety of surgical procedures which have
been
otherwise performed by open thoracotomy. The minimally invasive nature of
the
procedure, reduced postoperative pain, shortened hospital stay, and reduced
cost, are the potential advantages of VATS. While these merits are being
proven,
the limits to this technique are also getting clearer. In fact, VATS has
already
become a standard treatment of choice in several diseases, such as
bullectomy
for spontaneous pneumothorax and biopsy for indeterminate nodule and diffuse
interstitial lung disease, while others, such as major video-assisted lung
resection for lung carcinoma and resection of metastatic lung tumour, await
further evaluation of their roles in terms of oncological and technical
aspects.
Three issues that currently need to be addressed as the present role of
thoracoscopy evolves are instrumentation, economics, indication, and end
results
in certain procedures.
Publication Types:
Review
Review, Tutorial
PMID: 10339726 [PubMed - indexed for MEDLINE]
186: Respirology. 1999 Mar;4(1):1-8.
Video-assisted thoracic surgery: a renaissance in surgical therapy.
Yim AP, Izzat MB, Lee TW, Wan S.
Department of Surgery, Chinese University of Hong Kong, Prince of Wales
Hospital, China. yimap@cuhk.edu.hk
Within a few years, video-assisted thoracic surgery (VATS) has become the
accepted or preferred approach over a wide range of thoracic procedures. The
authors review the development of this technique, the basic operative
strategies
and the current surgical indications. Technical pitfalls and future
developments
are also discussed.
Publication Types:
Review
Review, Tutorial
PMID: 10339725 [PubMed - indexed for MEDLINE]
187: Surg Oncol Clin N Am. 1999 Apr;8(2):327-39.
Current management of thymoma.
Langenfeld J, Graeber GM.
Section of Cardiovascular and Thoracic Surgery, Department of Surgery, West
Virginia University School of Medicine, Morgantown, West Virginia
26506-9238,
USA.
Patients with thymoma present rarely even on active thoracic surgery
services.
These patients may suffer from many associated conditions but the most
common is
myasthenia gravis. Aggressive surgical resection is the mainstay of initial
therapy. Radiation therapy has a role in patients who are left with retained
neoplasm after surgical resection. Recurrence may occur at prolonged
intervals
but should be treated aggressively.
Publication Types:
Review
Review, Tutorial
PMID: 10339649 [PubMed - indexed for MEDLINE]
188: Chest. 1999 May;115(5 Suppl):122S-124S.
Choices in pain management following thoracotomy.
Peeters-Asdourian C, Gupta S.
Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA
02215,
USA.
Effective analgesia and blockade of the perioperative stress response may
improve outcome and accelerate recovery following thoracic surgery. Although
different approaches can achieve the same goal, it seems that a multimodal
pain
management based on the use of synergistic drugs provides better analgesia.
The
route of administration of the postoperative analgesic drugs is important,
and
epidural analgesia plays a role in the reduction of pulmonary complications.
Publication Types:
Review
Review, Tutorial
PMID: 10331344 [PubMed - indexed for MEDLINE]
189: Scand J Infect Dis. 1998;30(6):547-57.
Antibiotic prophylaxis in surgery: summary of a Swedish-Norwegian Consensus
Conference.
[No authors listed]
This consensus document sets out proposals for antibiotic prophylaxis in
abdominal, urological, gynaecological, orthopaedic, vascular and thoracic
surgery. As far as possible the recommendations are based on prospective
controlled trials. However, for some procedures, e.g. lung surgery and
implantation of pacemakers, documentation is lacking but antibiotic
prophylaxis
is given traditionally. The choice of antibiotics is generally conservative,
emphasizing that antibiotics used for therapy should be avoided in
prophylactic
regimens. Most recommendations are for the use of a first- or
second-generation
cephalosporin or an isoxazolyl penicillin, when necessary, combined with a
nitroimidazole derivative (metronidazole or tinidazole). Suggestions are
given
for more frequent use of orally administered antibiotics, such as
co-trimoxazole, doxycycline, metronidazole or tinidazole. Emphasis is put on
short-term prophylaxis. In most cases surgical antibiotic prophylaxis should
be
given as a single dose and in no case should the prophylaxis time exceed 24
h.
Publication Types:
Review
Review, Tutorial
PMID: 10225381 [PubMed - indexed for MEDLINE]
190: Pediatrics. 1999 May;103(5):e63.
Early video-assisted thoracic surgery in the management of empyema.
Grewal H, Jackson RJ, Wagner CW, Smith SD.
Department of Surgery, University of Kansas School of Medicine-Wichita,
Wichita
KS 67208, USA. hrgrewal@worldnet.att.net
OBJECTIVE: The appropriate timing, as well as the type of intervention, for
the
treatment of empyema in children is controversial. The advent of
video-assisted
thoracic surgery (VATS) has changed the way we treat these children. Therefore,
we reviewed our experience with the early use of VATS in the treatment of
empyema and formulated a treatment algorithm. METHODS: We retrospectively
reviewed medical records of all patients undergoing VATS for empyema at
Arkansas
Children's Hospital from December 1994 to February 1997. All patients were
treated by the pediatric surgical service and had the diagnosis of empyema
confirmed at surgery. Results are reported as means, unless otherwise noted.
RESULTS: Twenty-five children with empyema were treated with VATS during the
review period. Their age was 48.3 months, and the duration of symptoms was
7.4
days. All the patients had parapneumonic empyemas and had received
preoperative
antibiotics for 10.1 days. Preoperative imaging included chest radiography
in 25
(100%), ultrasonography in 20 (80%), and computed tomography in 10 (40%).
All
patients with documented loculated parapneumonic fluid collections underwent
VATS within a mean of 2 days of hospitalization. Chest tubes were removed in
3.2
days, resulting in a postoperative length of stay of 4.9 days. Total length
of
stay was 7.3 days. One patient required conversion to minithoracotomy and
required a transfusion. There were no other complications or deaths.
Follow-up
was available for 22 (88%) children, and there was resolution of symptoms in
all
children with no recurrences. CONCLUSIONS: Earlier intervention with VATS in
the
treatment of empyema in children is safe and may reduce hospital charges by
shortening hospital stay. A treatment algorithm based on early use of VATS
is
also described.
Publication Types:
Review
Review of Reported
Cases
PMID: 10224207 [PubMed - indexed for MEDLINE]
191: Drugs. 1999 Feb;57(2):233-60.
Aprotinin: an update of its pharmacology and therapeutic use in open heart
surgery and coronary artery bypass surgery.
Peters DC, Noble S.
Adis International Limited, Mairangi Bay, Auckland, New Zealand.
Cardiopulmonary bypass (CPB) is associated with defective haemostasis which
results in bleeding and the requirement for allogenic blood product
transfusions
in many patients undergoing open heart surgery (OHS) and/or coronary artery
bypass graft surgery (CABG) with CPB. Conservation of blood has become a
priority during surgery because of shortages of donor blood, the risks
associated with the use of allogenic blood products and the costs of these
products. Aprotinin is a serine protease inhibitor isolated from bovine lung
tissue which acts in a number of interrelated ways to provide an
antifibrinolytic effect, inhibit contact activation, reduce platelet
dysfunction
and attenuate the inflammatory response to CPB. It is used to reduce blood
loss
and transfusion requirements in patients with a risk of haemorrhage and has
clear advantages over placebo or no treatment. High dose aprotinin
significantly
reduces postoperative blood loss compared with aminocaproic acid and
desmopressin, and decreases transfusion requirements compared with
desmopressin.
Results are less consistent with tranexamic acid: high dose aprotinin either
reduces blood loss significantly more than, or to an equivalent level to,
tranexamic acid. A variety of other lower aprotinin dosage regimens
consistently
result in similar reductions in blood loss to aminocaproic acid or
tranexamic
acid. Data from clinical trials indicate that aprotinin is generally well
tolerated, and the adverse events seen are those expected in patients
undergoing
OHS and/or CABG with CPB. Hypersensitivity reactions occur in <0.1 to
0.6% of
patients receiving aprotinin for the first time. The results of original
reports
indicating that aprotinin therapy may increase myocardial infarction rates
or
mortality have not been supported by more recent studies specifically
designed
to investigate this outcome. However, a tendency to early vein graft
occlusion
with aprotinin has been shown and care with anticoagulation and vessel
grafts is
required. No comparative tolerability data between aprotinin and the lysine
analogues, aminocaproic acid and tranexamic acid, are available. CONCLUSION:
Comparative tolerability and cost-effectiveness data for aprotinin and the
lysine analogues are required to more fully assess their individual roles in
reducing blood loss and transfusion requirements in patients undergoing CPB
during OHS and/or CABG. However, clinical evidence to date supports the use
of
aprotinin over its competitors in patients at high risk of haemorrhage, in
those
for whom transfusion is unavailable or in patients who refuse allogenic
transfusions.
Publication Types:
Review
Review Literature
PMID: 10188764 [PubMed - indexed for MEDLINE]
192: Curr Opin Cardiol. 1993 Mar;8(2):237-43.
The results of cardiac valve procedures.
Weisel RD, Ikonomidis JS.
University of Toronto, Ontario, Canada.
Valvular procedures have become increasingly safe and efficacious. The number
of procedures and prostheses that are available increases each year. However, a
precise comparison of alternative treatments for patients with valvular
heart
disease requires an accurate and unbiased recording of the results. The
American Association for Thoracic Surgery and the Society of Thoracic
Surgeons
have developed guidelines that are intended to permit a comparison of
alternative procedures and prostheses employed in the treatment of patients
with
valvular heart disease. These guidelines have been followed by most recent
reports and have greatly facilitated the comparison of alternative treatment
strategies. Reports evaluating the long-term effects of valvular heart
surgery
should carefully state the population from which the sample was taken, the
adequacy of the follow-up, and the closing interval employed. Every attempt
should be made to document the causes of death or other adverse events,
because
if they are not adequately documented they must be assumed to be valve
related.
Recent studies have demonstrated that age was the major predictor of
structural
valve failure at 10 years after bioprosthetic implantation. To avoid
bioprosthetic failure some surgeons have employed a stentless porcine aortic
valve or a homograft prosthesis.
Both of these approaches will require the test
of time. To compare alternative
treatments, definitions and reporting
techniques must be uniform. The
guidelines have been adopted by most authors
reporting the long-term results of valve procedures.
Publication Types:
Review
Review, Tutorial
PMID: 10148394 [PubMed - indexed for MEDLINE]
193: J Am Coll Surg. 1999 Feb;188(2):104-10.
Cardiac surgery.
Verrier ED.
University of Washington School of Medicine, Seattle, USA.
Publication Types:
Review
Review, Tutorial
PMID: 10024151 [PubMed - indexed for MEDLINE]
194: Semin Hematol. 1999 Jan;36(1 Suppl 1):37-41.
Management of heparin-induced thrombocytopenia: a cardiovascular surgeon's
perspective.
Blakeman B.
Loyola University Medical Center, Maywood, IL 60153, USA.
Three areas involved with heparin-induced platelet activation (HIPA) need to
be
discussed from a cardiovascular surgeon's perspective. These include the
clinical presentation and management of HIPA-associated events, preparation
for
surgery in patients with existing HIPA, and medical-legal considerations
surrounding HIPA-associated events and treatment. The incidence of
heparin-induced thrombocytopenia (HIT) is approximately 1% to 5% of surgical
patients. As many as 35% of these patients experience heparin-induced
thrombocytopenia and thrombosis syndrome (HITTS), which generally results in
devastating outcomes. The initial management of all patients with HIT and
HITTS
involves withdrawal of heparin. Thereafter, treatment of HITTS should
include
aggressive interventions with antithrombin agents, plasmapheresis, and
possibly
thrombolytic agents. Surgery for patients with existing HIPA needs to be
carefully planned. Once all nonsurgical avenues have been explored, surgery
should be performed following proper planning and education of patient and
family. Finally, the number of lawsuits directly related to outcomes in
cases
involving HIT and HITTS is increasing. Cardiovascular surgeons should be
well
prepared, limiting their exposure to potential litigation with good clinical
management and complete clinical and laboratory documentation.
Publication Types:
Review
Review, Tutorial
PMID: 9930563 [PubMed - indexed for MEDLINE]
195: Chest Surg Clin N Am. 1998 Nov;8(4):835-51.
Video-assisted thoracic surgery pericardial resection for effusive disease.
Flores RM, Jaklitsch MT, DeCamp MM Jr, Sugarbaker DJ.
Division of Thoracic Surgery, Brigham and Women's Hospital, Harvard Medical
School, Boston, Massachusetts, USA.
In patients who can tolerate single-lung ventilation and who have a long
life
expectancy, VATS offers definitive and durable treatment without the
morbidity
of an open thoracotomy. The patients who may benefit most from this
technique
include those with benign effusive disease, patients with malignant
pericardial
effusions with a good prognosis, and patients with concurrent pulmonary
pathology.
Publication Types:
Review
Review, Tutorial
PMID: 9917928 [PubMed - indexed for MEDLINE]
196: Chest Surg Clin N Am. 1998 Nov;8(4):789-807, viii.
Video-assisted thoracic surgery for lung volume reduction surgery.
Fischel RJ, McKenna RJ Jr.
Department of Thoracic Surgery, Cedars-Sinai Medical Center Lung Center, Los
Angeles, California, USA.
Lung volume reduction surgery by video thoracoscopy can result in
significant
improvement in quality of life and pulmonary function for selected patients
suffering from severe emphysema. Clinical trials comparing the use of lasers
versus staples, unilateral versus bilateral procedures, and video surgery
versus
mediansternotomy are summarized. Patient selection and patient care issues
are
addressed. Information gathered from the selection, evaluation, and study of
almost 500 patients treated surgically for emphysema at a single institution
is
summarized.
Publication Types:
Review
Review, Tutorial
PMID: 9917926 [PubMed - indexed for MEDLINE]
197: Chest Surg Clin N Am. 1998 Nov;8(4):775-85, viii; discussion
787-8.
The current status of video-assisted thoracic surgery lobectomy.
McKenna RJ Jr.
Department of Thoracic Surgery, University of California, Los Angeles, USA.
Video-assisted thoracic surgery (VATS) lobectomy appears to be a safe
procedure
that may have advantages over lobectomy by thoracotomy for selected
patients.
The published series of VATS lobectomies for lung cancer suggest that
lobectomy
by VATS offers survival comparable to that of lobectomy by thoracotomy. VATS
lobectomy is associated with a low morbidity and mortality and, perhaps, a
shorter length of stay than thoracotomy. VATS lobectomy is a reasonable
treatment option for selected patients with Stage I lung cancer when it is
performed by surgeons with the skills to perform a complete cancer operation
via
VATS.
Publication Types:
Review
Review, Tutorial
PMID: 9917925 [PubMed - indexed for MEDLINE]
198: Chest Surg Clin N Am. 1998 Nov;8(4):907-17, x.
Complications after video-assisted thoracic surgery.
Downey RJ.
Division of Thoracic Surgery, Memorial Sloan-Kettering Cancer Center, New
York,
New York, USA.
Video-assisted thoracic surgery (VATS) procedures have been adopted widely
and
rapidly for the treatment of a wide range of benign and malignant thoracic
disorders. To date, there is only incomplete information available about the
complications associated with these techniques. In this article, the
available
literature addressing the types and incidence of postoperative complications
associated with VATS procedures is reviewed, as are the problems of
incisional
pain, alterations in respiratory function, and dissemination of malignancy
following manipulation of tumors by VATS techniques.
Publication Types:
Review
Review, Tutorial
PMID: 9917932 [PubMed - indexed for MEDLINE]
199: Chest Surg Clin N Am. 1998 Nov;8(4):853-70, ix.
The role of video-assisted thoracic surgery in esophageal disease.
Gamliel Z, Krasna MJ.
Division of Thoracic and Cardiovascular Surgery, University of Maryland
School
of Medicine, Baltimore, USA. zgamliel@surgery1.ab.umd.edu
Numerous applications of video-assisted thoracic surgery (VATS) in the
management of diseases of the esophagus for structural, functional, benign,
and
malignant conditions have been reported. Indications and techniques for the
use
of VATS in the assessment and treatment of esophageal disease are discussed
in
this article. The need for careful evaluation of the safety, efficacy, and
cost-effectiveness of these techniques is emphasized.
Publication Types:
Review
Review, Tutorial
PMID: 9917929 [PubMed - indexed for MEDLINE]
200: Chest Surg Clin N Am. 1998 Nov;8(4):809-25, viii; discussion
827-34.
Video-assisted thoracic surgery thymectomy for myasthenia gravis.
Mack MJ, Scruggs G.
Cardiopulmonary Research Science and Technology Institute, Dallas, Texas,
USA.
Video-assisted thoracic surgery thymectomy was employed in the management of
myasthenia gravis in a series of 20 patients. As the technique evolved, the
authors preferred a right-sided approach, and the technical details of the
process are discussed. At a mean follow-up of 30 months, clinical results
are
comparable to published series of other approaches. It is hoped that the
superior cosmesis associated with this less-invasive approach leads to
earlier
thymectomy in management of this disease.
Publication Types:
Review
Review, Tutorial
PMID: 9917927 [PubMed - indexed for MEDLINE]
201: Chest Surg Clin N Am. 1998 Nov;8(4):763-74, vii.
Video-assisted thoracic surgery for diagnosis of the solitary lung nodule.
Hazelrigg SR, Magee MJ, Cetindag IB.
Department of Surgery, Southern Illinois University School of Medicine,
Springfield, USA.
The finding of a solitary pulmonary nodule is a frequent clinical problem.
This
article outlines the current recommendation for diagnostic management.
Video-assisted thoracic surgery (VATS) has emerged as an excellent
diagnostic
tool that can reduce the incidence of thoracotomy for benign nodules while
allowing expeditious treatment of early malignancies. The surgical
techniques of
VATS are discussed.
Publication Types:
Review
Review, Tutorial
PMID: 9917924 [PubMed - indexed for MEDLINE]
202: Heart Lung. 1999 Jan-Feb;28(1):15-9.
Video-assisted thoracic surgery (VATS).
Rao A, Bansal A, Rangraj M, Grant GR, Papamichael MJ, Nepomuceno A, Giarolo
I,
Brandstetter RD.
Department of Surgery, Sound Shore Medical Center of Westchester, New
Rochelle,
NY 10802, USA.
Publication Types:
Review
Review, Tutorial
PMID: 9915927 [PubMed - indexed for MEDLINE]
203: Ann Thorac Cardiovasc Surg. 1998 Dec;4(6):351-3.
Thoracoscopic resection of a giant leiomyoma of the esophagus with a
mediastinal
outgrowth.
Tamura K, Takamori S, Tayama K, Mitsuoka M, Hayashi A, Fujita H, Shirouzu K.
Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi,
Kurume 830-0011.
We reported a case of a 20-year-old man with a giant leiomyoma of the
esophagus
resected under video-assisted thoracic surgery (VATS). The patient
demonstrated
an abnormal shadow on a chest x-ray and a posterior mediastinal tumor 11 cm
in
diameter on a computed tomogram (CT) and on magnetic resonance imaging
(MRI). A
leiomyoma or a neurogenic tumor of the esophagus was suspected, and VATS was
performed. The resected tumor was pathologically confirmed to be a leiomyoma
of
the esophagus. A giant esophageal leiomyoma showing extraluminal outgrowth
should be treated by VATS.
Publication Types:
Case Reports
Review
Review of Reported
Cases
PMID: 9914465 [PubMed - indexed for MEDLINE]
204: Surg Endosc. 1999 Jan;13(1):3-9.
Analysis of thoracoscopy in trauma.
Villavicencio RT, Aucar JA, Wall MJ Jr.
Department of Surgery, 497 Scaife Hall, University of Pittsburgh,
Pittsburgh, PA
15261, USA.
BACKGROUND: The role of video-assisted thoracic surgery (VATS) in trauma has
yet
to be established. Up to the time of this writing, reviews of thoracoscopy
in
trauma have been primarily descriptive rather than analytic. This article
analyzes the results of thoracoscopy (nonvideo and VATS) in trauma. METHODS:
Analysis was done by reviewing 28 nonoverlapping studies since the
introduction
of thoracoscopy in 1910, with a combined total of more than 500 patients.
RESULTS: Diagnostically, thoracoscopy has been used primarily to evaluate
diaphragmatic injury, continued chest tube bleeding, and suspected cardiac
injury. Thoracoscopy has a 98% (188/191 patients) accuracy rate in
diagnosing
diaphragmatic injuries. Therapeutically, thoracoscopy has been used
primarily to
control chest tube bleeding, evacuate retained hemothoraces, and evacuate
empyemas. Thoracoscopy is 90% (89/99 patients) effective in evacuating
retained
hemothoraces, 86% (19/22 patients) effective in evacuating empyemas, and 82%
(33/40 patients) effective in controlling chest tube bleeding. Thoracoscopy
benefits include preventing 62% (323/514) of trauma patients from having a
thoracotomy or laparotomy. Risks include a 2% (11/534 patients)
procedure-related complication rate and a 0.8% (4/471 patients) missed
injury
rate. Technical failure rates are 10% (10/99 patients) and 4% (7/199
patients)
in evacuation of retained hemothoraces and evaluation of diaphragmatic
injuries,
respectively. CONCLUSIONS: Analysis suggests that thoracoscopy (nonvideo and
VATS) can be applied safely and effectively in the care of the injured
patient.
Publication Types:
Review
Review, Tutorial
PMID: 9869678 [PubMed - indexed for MEDLINE]
205: Cardiol Young. 1998 Oct;8(4):437-9.
Comment in:
Cardiol Young.
1998 Oct;8(4):425-7.
Pediatric cardiac surgery in Indonesia.
Asou T, Rachmat J.
Harapan Kita National Cardiac Center, Jakarta, Indonesia.
Pediatric cardiac surgery in Indonesia first developed thanks to the
cooperation
of various cardiac centers abroad. The establishment of the 'Harapan Kita'
National Cardiac Center in 1985 was one of the most important initial steps.
Thereafter, the discipline advanced remarkably in terms of the number of the
operations performed and the variety of the diseases treated and, as a
result,
the surgical outcome also improved. Numerous problems remain to be solved.
Only
1% of the children with congenital heart disease are today properly treated
in
Indonesia. Some of the underlying problems responsible for this situation
include a shortage of pediatric cardiac professionals, the lack of the
information and education on the part of the patients, and a shortage of
funding, both privately and publicly. It would thus be welcome for pediatric
cardiac surgeons, cardiologists and nurses in Indonesia to learn about
congenital heart disease from doctors and nurses in advanced countries in
order
to improve the outlook at home.
Publication Types:
Historical Article
Review
Review, Tutorial
PMID: 9855095 [PubMed - indexed for MEDLINE]
206: AANA J. 1998 Jun;66(3):253-61.
AANA Journal Course: update for nurse anesthetists--anesthesia for thoracic
surgery: lung separation.
Benumof JL.
University of California, San Diego Medical Center, Department of
Anesthesia,
USA.
The lungs can be separated by use of either a double-lumen tube (DLT) or a
bronchial blocker (BB). Correct positioning of DLTs and BBs is often the
most
important determinant as to whether thoracic surgery cases (in particular
one-lung ventilation cases) and differential lung ventilation in the
intensive
care unit proceed smoothly. If the method of lung separation is correct, the
operative nondependent lung will collapse completely and easily, the surgeon
will be able to work efficiently without damaging the operative lung, and
the
nonoperative lung will be unobstructed and easy to ventilate. For both DLTs
and
BBs, the key to precise positioning is to visualize, with a fiberoptic
bronchoscope, through the tracheal lumen, the occluding endobronchial
cuff/balloon just below the tracheal carina.
Publication Types:
Review
Review, Tutorial
PMID: 9830853 [PubMed - indexed for MEDLINE]
207: Semin Thorac Cardiovasc Surg. 1998 Oct;10(4):326-31.
Thoracoscopic major lung resections: an Asian perspective.
Yim AP, Izzat MB, Liu HP, Ma CC.
Department of Surgery, Prince of Wales Hospital, Hong Kong.
The application of video-assisted thoracic surgery (VATS) for major lung
resection is controversial. We review our combined experience from three
centers
in Asia. From June 1993 through June 1997, 214 patients underwent VATS major
resections (2 segmentectomies, 203 lobectomies, 6 bilobectomies, 3
pneumonectomies), mostly for primary malignancy. Stringent selection
criteria
were used to choose patients for this approach. We prefer a technique of not
spreading ribs, using conventional thoracic instrument for dissection and
routine use of wound protector for specimen retrieval. There was one
postoperative surgical death and 47 non-fatal complications, which compare
favorably with published series on open technique. Of the primary lung
cancer
patients, 93% are still alive after a mean follow-up of 26 months. We
conclude
that VATS major lung resection is technically feasible in selected patients
and
associated with favorable intermediate-term results.
Publication Types:
Review
Review of Reported
Cases
PMID: 9801255 [PubMed - indexed for MEDLINE]
208: Eur J Cardiothorac Surg. 1998 Sep;14(3):223-8.
Cardiac surgery beyond the Urals.
Borst HG.
Publication Types:
Editorial
Review
Review, Tutorial
PMID: 9761429 [PubMed - indexed for MEDLINE]
209: Chest Surg Clin N Am. 1998 Aug;8(3):633-43.
Neurologic complications in thoracic surgery.
Feins RH.
University of Rochester Medical Center, New York, USA.
In this article, a significant number of neurologic conditions have been
presented that have importance to the thoracic surgeon. The most important
point, however, is that most of the neurologic complications are avoidable
by
careful surgical technique and preoperative and postoperative care.
Publication Types:
Review
Review, Tutorial
PMID: 9742340 [PubMed - indexed for MEDLINE]
210: Chest Surg Clin N Am. 1998 Aug;8(3):557-83, viii-ix.
Adult respiratory failure.
Tremblay A, Gursahaney A.
McGill University Internal Medicine Training Program, Montreal General
Hospital,
Quebec, Canada.
Pulmonary complications following thoracic surgery are common and associated
with significant morbidity and mortality. In particular, acute respiratory
distress syndrome (ARDS) can occur postoperatively or after trauma. This
syndrome, when complicated by multisystem organ failure, often leads to a
poor
outcome. This article describes the etiology and pathophysiology of ARDS and
evaluates recent advances in pharmacological and nonpharmacological
therapies.
In addition, newer modalities of mechanical ventilatory support are
reviewed.
Publication Types:
Review
Review, Academic
PMID: 9742337 [PubMed - indexed for MEDLINE]
211: Chest Surg Clin N Am. 1998 Aug;8(3):541-55, viii.
Preparation of high-risk patients for major thoracic surgery.
Bisson A, Stern M, Caubarrere I.
Thoracic Surgery Unit, Foch Hospital, Suresnes, France.
For a least a decade, many patients have benefitted from new indications of
major thoracic surgery owing to improvements in the surgical and anesthetic
procedures of thoracic surgery. Identification of risk factors of
perioperative
morbidity and mortality becomes of paramount importance when trying to
lesson
the postoperative mortality rate to 1% or less. The careful assessment of
the
candidates for thoracic surgery with a multidisciplinary approach is the
cornerstone of such an objective. The lower mortality rate should be
achievable
with a preoperative preparation of the patients of a rehabilitation and
nutritional program and a pharmacologic treatment optimization.
Publication Types:
Review
Review, Tutorial
PMID: 9742336 [PubMed - indexed for MEDLINE]
212: Chest Surg Clin N Am. 1998 Aug;8(3):495-502, vii.
Myocardial ischemia and infarction postthoracotomy.
Herrington CS, Shumway SJ.
Division of Cardiovascular and Thoracic Surgery, University of Minnesota,
Minneapolis, USA.
The best long-term survival for any given lung cancer patient is provided by
surgical resection. However, pneumonectomy still has the highest mortality
rates, often due to cardiac complications. Risk assessment can be aided by
preoperative evaluation of thoracic surgery patients. The role of right
heart
function, intraoperative management, and postoperative conditions in
myocardial
ischemia and infraction are analyzed, and the benefits of different kinds of
resection are weighed in light of possible cardiac complications.
Publication Types:
Review
Review, Tutorial
PMID: 9742333 [PubMed - indexed for MEDLINE]
213: Chest Surg Clin N Am. 1998 Aug;8(3):479-93, vii.
Cardiac arrhythmias.
Amar D.
Department of Anesthesiology, Cornell University Medical College, New York,
New
York, USA.
Supraventricular dysrhythmias (SVDs) present the most frequent medical
complication after thoracic surgery and have been associated with prolonged
hospital stays. The reported incidence of SVDs in the thoracic surgery
patient
population ranges from 10% to 40%, with factors such as age and extent of
surgery markedly influencing the incidence. This article focuses on new
issues
leading to improved understanding of the pathophysiology and mechanisms of
SVDs
after surgery. New approaches directed at prophylaxis and acute therapy of
SVDs
are discussed, as are recommendations to prevent thromboembolic events due
to
atrial dysrhythmias following thoracic surgery.
Publication Types:
Review
Review, Tutorial
PMID: 9742332 [PubMed - indexed for MEDLINE]
214: Ann Thorac Surg. 1998 Aug;66(2):592-9.
Minimally invasive management for first and recurrent pneumothorax.
Massard G, Thomas P, Wihlm JM.
Department of Thoracic Surgery, Hopitaux Universitaires de Strasbourg,
France.
Gilbert.Massard@chru-strasbourg.fr
Minimally invasive techniques for treatment of pneumothorax should yield the
standard of results set with open procedures: the operative morbidity should
remain less than 15%, and the recurrence rate less than 1%. In the era
before
video-assisted thoracic surgery, two minimally invasive variants were used.
Chemical pleurodesis resulted in an unsatisfactory recurrence rate of at
least
15%. In contrast, pleurectomy and apical stapling performed through a
transaxillary minithoracotomy compared favorably with larger thoracotomy
approaches, and allowed a reduced hospital stay. Evaluation of
video-assisted
thoracic surgical operations for spontaneous pneumothorax is hampered by a
lack
of controlled studies. The general impression is that morbidity did not
decline
significantly; the main determinant of complications is the patient's
underlying
health status. However, published recurrence rates range from 5% to 10%, in
spite of a shorter follow-up time span. Optimized results are achieved when
classic principles combining apical wedge resection and pleurodesis are
applied.
Reduction of hospital stay is not only a result of the new technology, but
also
changing drainage and discharge policies. Reduction of cost is debatable,
because many studies do not consider the cost of video equipment. The main
advantage when compared with open thoracotomy is reduction of postoperative
pain. The only two available controlled studies conclude that there is no
obvious advantage of video-assisted thoracic surgery when compared with
conventional limited-access surgery. The future role of video-assisted
thoracic
surgery in this disease remains to be determined by a large-scale
prospective
evaluation.
Publication Types:
Review
Review Literature
PMID: 9725423 [PubMed - indexed for MEDLINE]
215: J Ky Med Assoc. 1998 May;96(5):174-81.
New technology in diagnosis and treatment of diseases of the pleural space.
Carrillo EH, Linker RW, Richardson JD.
Department of Surgery, University of Louisville, KY, USA.
Recent developments in video camera technology, new instruments, and
advanced
surgical techniques have increased the importance of video-assisted
thoracoscopic surgery (VATS). Currently, VATS offers a new approach in the
diagnosis and treatment of many thoracic conditions previously treated only
by
standard thoracotomy. In our experience, VATS is a safe, reliable, and
effective
alternative to thoracic surgery. With further improvements and refinements
in
video imaging and endoscopic instruments, more procedures will be
technically
feasible. The long-term results of VATS compared to open thoracotomy will
require extensive follow up and prospective trials to determine its true
value.
Publication Types:
Review
Review, Tutorial
PMID: 9613043 [PubMed - indexed for MEDLINE]
216: Eur Respir J. 1998 Jan;11(1):213-21.
Thoracoscopy--state of the art.
Loddenkemper R.
Lungenklinik Heckeshorn, Berlin, Germany.
"Medical" thoracoscopy as compared with "surgical"
thoracoscopy (which is more
precisely known as video-assisted thoracic surgery (VATS)) has the advantage
that it can be performed under local anaesthesia or conscious sedation, in
an
endoscopy suite, using nondisposible rigid instruments. Thus, it is
considerably
less invasive and less expensive. The main diagnostic and therapeutic
indications for medical thoracoscopy are pleural effusions and pneumothorax.
Due
to its high diagnostic accuracy, approaching almost 100% in malignant and
tuberculous pleural effusions, it should be used when pleural fluid analysis
and
needle biopsy are nondiagnostic. In addition, medical thoracoscopy provides
staging for lung cancer and diffuse malignant mesothelioma. Talc poudrage,
as
the best conservative method for pleurodesis in 1998, can also be performed
with
medical thoracoscopy. It can also be effectively used in the early
management of
empyema. In spontaneous pneumothorax it allows staging, thereby facilitating
treatment decisions, and in addition coagulation of eventual blebs and talc
poudrage for efficient pleurodesis. Medical thoracoscopy is a safe procedure
which is even easier to learn than flexible bronchoscopy. Due to its high
diagnostic and therapeutic efficiency, it should be applied increasingly in
the
management of the above-mentioned pleuropulmonary diseases.
Publication Types:
Review
Review, Tutorial
PMID: 9543295 [PubMed - indexed for MEDLINE]
217: Curr Opin Oncol. 1998 Mar;10(2):146-50.
Surgical management of pulmonary metastases.
Pass HI.
Harper Hospital, Karmanos Cancer Institute, Detroit, MI 48201, USA.
The management of pulmonary metastases remains controversial. More
information
is available, however, on outcomes in larger series of patients undergoing
metastasectomy as well as the indications for the procedure. The role of
video-assisted thoracic surgery for the diagnosis and management of these
patients is being scrutinized carefully. Isolated perfusion techniques for
treating patients with unresectable pulmonary metastases have been applied
in
phase I and II trials at selected institutions. More data regarding clinical
outcomes are necessary, however, before widespread adaptation of this
experimental form of treatment is accepted as standard practice.
Publication Types:
Review
Review, Tutorial
PMID: 9555538 [PubMed - indexed for MEDLINE]
218: Chest Surg Clin N Am. 1998 Feb;8(1):59-76.
The role of video-assisted thoracic surgery in pulmonary metastases.
Ferson PF, Keenan RJ, Luketich JD.
Division of Cardiothoracic Surgery, University of Pittsburgh School of
Medicine,
Pennsylvania, USA.
The role of VATS in the management of patients with isolated pulmonary
metastases is clear when performed for diagnostic purposes. In those
patients
with metastases that are too small for needle biopsy, when needle biopsy has
been unsuccessful, or when more tissue is necessary for analysis, a VATS
wedge
resection can be performed with a high degree of success and minimal
morbidity
or inconvenience. The value of VATS for therapeutic resection of pulmonary
metastases has not been demonstrated. Ideally, multicenter trials could
address
this issue along with the many unanswered questions concerning the
fundamental
concept of resection of pulmonary metastases.
Publication Types:
Review
Review, Tutorial
PMID: 9515173 [PubMed - indexed for MEDLINE]
219: J Am Coll Surg. 1998 Feb;186(2):162-72.
General thoracic surgery.
Faber LP.
Rush Medical College, Rush-Presbyterian St. Luke's Medical Center, Chicago,
IL,
USA.
Publication Types:
Review
Review, Tutorial
PMID: 9482619 [PubMed - indexed for MEDLINE]
220: Int Surg. 1997 Jul-Sep;82(3):223-8.
Thoracoscopy for trauma.
Frame SB.
Department of Surgery, University of Tennessee Graduate School of Medicine,
Knoxville 37920, USA.
Thoracoscopy is currently undergoing a revival in the surgical world. As the
role of thoracoscopy increases in the general thoracic surgery arena, the
indications for the technique in the care of trauma patients is also
expanding.
Trauma surgeons are investigating both diagnostic and therapeutic
indications.
Penetrating thoracoabdominal trauma is a proven indication to evaluate the
diaphragm for possible violation. Investigation of thoracic hemorrhage with
identification of bleeding sites, evacuation of hemothorax, and control of
ongoing blood loss have all been reported successfully via the thoracoscope.
Recent reports have sited isolated patients were diaphragmatic repair has
been
accomplished with endoscopic techniques. Other indications await the
improvement
of techniques and instruments, and the imagination of future surgeons.
Publication Types:
Review
Review Literature
PMID: 9372363 [PubMed - indexed for MEDLINE]
221: Int Surg. 1997 Jul-Sep;82(3):217-22.
Cardiac applications of video assisted thoracic surgery.
Mack MJ, Landreneau RJ, Yong P, Acuff TE.
Department of Cardiothoracic Surgery, Medical City Dallas Hospital, TX, USA.
As experience with video assisted thoracic surgery (VATS) has grown, cardiac
applications of VATS are being explored. Simple cardiac procedures including
pericardiectomy and epicardial pacemaker lead placement are readily
accomplished
by VATS. More complex cardiac procedures are being investigated both in the
laboratory and in the clinical arena. Totally endoscopic coronary artery
bypass
grafting has been successfully performed in the animal model. Modification
of
existing instrumentation and techniques has had an enabling benefit. The
human
experience consists of predominantly a video assisted minithoracotomy
approach
with some successful promise. More advanced procedures including minimally
invasive valve replacement are also being explored.
Publication Types:
Review
Review Literature
PMID: 9372362 [PubMed - indexed for MEDLINE]
222: Can J Cardiol. 1997 Dec;13 Suppl D:58D-63D.
Revascularization in Canada: manpower and resource issues.
Gelfand ET, Knudtson ML, Galbraith D.
University of Alberta, Edmonton.
Publication Types:
Consensus
Development Conference
Review
PMID: 9444310 [PubMed - indexed for MEDLINE]
223: Chest. 1998 Jan;113(1 Suppl):6S-12S.
The role of thoracoscopy in lung cancer management.
Landreneau RJ, Mack MJ, Dowling RD, Luketich JD, Keenan RJ, Ferson PF,
Hazelrigg
SR.
Allegheny University of the Health Sciences, Pittsburgh, PA 15212-4772, USA.
Video-assisted thoracic surgery (VATS) has enabled more complex procedures
previously requiring thoracotomy to be accomplished in lung cancer
management.
VATS today can be employed in the evaluation of idiopathic (and known)
malignant
pleural effusions, mediastinal adenopathy, indeterminate pulmonary nodules,
and
compromise resection and lobectomy of peripheral stage I non-small cell lung
cancer. Thus, VATS is becoming an accepted approach to a variety of
intrathoracic problems, although its absolute indications for patients with
lung
cancer have yet to be firmly defined. This article reviews the authors'
current
experience with VATS procedures in the treatment of patients with lung
cancer.
Publication Types:
Review
Review, Tutorial
PMID: 9438683 [PubMed - indexed for MEDLINE]
224: Eur Respir J. 1997 Nov;10(11):2653-6.
Clear cell sarcoma: an extremely rare cause of pleural disease.
Bury T, Hermans G, Alexis-Agnant R, Chevalier P, Limet R, Bartsch P.
Dept of Pneumology, CHU Liege, Belgium.
We present the case of a 36 yr old woman with a persisting complaints of
left
chest pain. A chest radiograph revealed multiple left pleural thickenings.
Classical exploration was negative. Thoracic surgery allowed the subtotal
removal of a huge pleural tumour. The histological examination revealed a
clear
cell sarcoma. The literature on this extremely rare tumour is reviewed.
Publication Types:
Case Reports
Review
Review of Reported
Cases
PMID: 9426110 [PubMed - indexed for MEDLINE]
225: Chest Surg Clin N Am. 1997 Nov;7(4):831-68.
Anesthesia for the pediatric patient.
McDowall RH.
Department of Anesthesiology, Memorial Sloan-Kettering Cancer Center, New
York,
New York, USA.
Infants and children have unique anatomic, physiologic, pharmacologic, and
psychological issues relating to perioperative management. Combining this
knowledge with the technical skills required for instrumentation of children
is
essential when contemplating anesthesia for thoracic surgery. Experience and
versatility with anesthetic induction technique, airway instrumentation,
vascular access and monitoring, single-lung ventilation, regional
anesthesia,
and postoperative pain management allow for the comprehensive management of
thoracic surgical patients at any age.
Publication Types:
Review
Review, Tutorial
PMID: 9403194 [PubMed - indexed for MEDLINE]
226: Chest Surg Clin N Am. 1997 Nov;7(4):817-29.
Prevention and management of dysrhythmias following thoracic surgery.
Amar D.
Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
Supraventricular dysrhythmias (SVDs) occur frequently after thoracic surgery
and
have been associated with prolonged hospital stays. The reported incidence
of
supraventricular dysrhythmias in the thoracic surgery patient population
ranges
from 10% to 40%, with factors such as age and extent of surgery markedly
influencing the incidence. This article focuses on new issues leading to
improved understanding of the pathophysiology and mechanisms of SVDs after
surgery. New approaches directed at prophylaxis and acute therapy of SVDs
are
also discussed.
Publication Types:
Review
Review, Tutorial
PMID: 9403193 [PubMed - indexed for MEDLINE]
227: Chest Surg Clin N Am. 1997 Nov;7(4):735-51.
Lung isolation. Tube design and technical approaches.
Wilson RS.
Department of Anesthesiology and Critical Care Medicine, Memorial
Sloan-Kettering Cancer Center, New York, New York, USA.
Airway management for thoracic surgery frequently requires isolation of a
portion of the respiratory system. In some circumstances lung isolation is
mandatory and in others elective. Several techniques utilizing specialized
endotracheal tubes and blockers are currently available. There are specific
advantages and complications associated with each that, in part, determine
optimal outcome in this specialized group of surgical patients.
Publication Types:
Review
Review, Tutorial
PMID: 9403189 [PubMed - indexed for MEDLINE]
228: Chest Surg Clin N Am. 1997 Nov;7(4):721-33.
Intraoperative monitoring.
Desiderio DP.
Department of Anesthesiology and Critical Care Medicine, Memorial
Sloan-Kettering Cancer Center, New York, New York, USA.
This article discusses some of the routine as well as more specialized
monitoring devices available. In thoracic surgery monitoring may be even
more
challenging because the surgery itself may involve manipulation of the
airways,
the pulmonary as well as cardiovascular systems. The anesthesiologist must
have
a full understanding of the required monitoring devices and decide which if
any
special techniques are needed depending on the surgical procedure and the
patient's preoperative condition.
Publication Types:
Review
Review, Tutorial
PMID: 9403188 [PubMed - indexed for MEDLINE]
229: Chest Surg Clin N Am. 1997 Nov;7(4):641-54.
Preoperative pulmonary evaluation of the thoracic surgical patient.
Melendez JA, Fischer ME.
Department of Anesthesiology and Critical Care, Memorial Sloan-Kettering Cancer
Center, New York, New York, USA.
A test designed to separate those undergoing thoracic surgery without
complications and those with complications must be both highly specific and
sensitive. Clearly, the difference between patients at opposite ends of the
population curves is easy to identify. Spirometry can be helpful for
screening,
although it is not a very discriminating test. If patients fall in the
overlap
region between the populations, however, it is impossible to discern the
risks
with any certainty using low-yield tests. A test with higher sensitivity,
specificity, and predictive values is necessary to ascertain such marginal
differences. With this kind of analysis at hand, preoperative testing can be
divided into three predictive value groups. Calculating the predictive value
of
each preoperative test can provide a comparative measure of usefulness of
discriminative power (Table 1). In this way, spirometry, blood gas analysis,
and
stair climbing tolerance are shown to be poor predictors of outcome. An
intermediate predictive value can be achieved using diffusion capacity,
exercise-induced decreases in O2 saturation, and exercise PVR. High
predictive
value can be accomplished with combination indexes (PPP, possibly PRQ),
measurement of VO2 at 40 watts of exercise, or VO2max. Logic dictates a
step-wise preoperative evaluation using prediction value analysis (Fig.4). A
flow decision chart for the preoperative evaluation of patients for
pulmonary
resection begins with exercise oximetry, spirometry, and blood gas analysis
as
general screening tests to separate those patients at minimal or no risks
for
complications from those patients that require further evaluation.
Functional
indexes (PPP, PRQ) or exercise testing can aid further in the selection of
those
patients in whom a nonsurgical option should be considered. Flow decision
chart
for the preoperative evaluation of patients for pulmonary resection should
continue to evolve as new information about outcome studies is gathered.
Examination of outcome data will provide us with reduction of the size of
the
nonoperable population, so that we can deny only those patients who truly
pose a
prohibitive risk.
Publication Types:
Review
Review, Tutorial
PMID: 9403184 [PubMed - indexed for MEDLINE]
230: J Thorac Imaging. 1997 Oct;12(4):285-92.
Image-guided localization for video-assisted thoracic surgery.
Spirn PW, Shah RM, Steiner RM, Greenfield AL, Salazar AM, Liu JB.
Department of Radiology, Thomas Jefferson University Hospital, Philadelphia,
Pennsylvania 19107, USA.
Video-assisted thoracic surgery (VATS) has become a useful diagnostic and
therapeutic tool in the management of lung, pleural, and mediatstinal
disease.
Preoperative image-guided localization is performed to aid the surgeon in
the
thoracoscopic resection of small lung lesions that would otherwise be
difficult
to resect. This article describes the techniques of localization and reviews
our
experience with this procedure. While the majority of localization
procedures
are performed during an immediately preoperative computed tomography (CT),
the
use of intraoperative lesion localization using an endosonographic probe has
been reported. The need for localization before resection is dependent on
the
skill and experience of the thoracoscopist and the characteristics of the
lung
lesions.
Publication Types:
Review
Review, Tutorial
PMID: 9368223 [PubMed - indexed for MEDLINE]
231: Curr Opin Pulm Med. 1995 Jul;1(4):331-8.
The etiology and treatment of spontaneous pneumothorax.
Sassoon CS.
Pulmonary and Critical Care Section (111P), Department of Veterans Affairs
Medical Center, Long Beach, CA 90822, USA.
In the past year, studies on spontaneous pneumothorax have focused on
etiology
and treatment. Chronic obstructive pulmonary disease remains the most common
cause of secondary spontaneous pneumothorax. However, Pneumocystis carinii
infections in patients who have AIDS have become the leading cause of
spontaneous pneumothorax in a population where its prevalence is high. One
of
the treatment modalities of spontaneous pneumothorax is tube thoracostomy
with
the instillation of tetracycline as the sclerosing agent. Tetracycline is no
longer available. Fortunately, its derivatives doxycycline and minocycline
are
equally effective. Talc in slurry or insufflated appears to be more
effective
than tetracycline derivatives. Experience with talc in slurry for the
treatment
of spontaneous pneumothorax is still limited. Another treatment modality for
spontaneous pneumothorax is thoracoscopy, more recently termed
video-assisted
thoracic surgery, and it has warranted renewed interest due to the advent of
improved endoscopic technology. In the treatment of spontaneous
pneumothorax,
video-assisted thoracic surgery is nearly as effective as thoracotomy.
Publication Types:
Review
Review, Tutorial
PMID: 9363073 [PubMed - indexed for MEDLINE]
232: Chest. 1997 Oct;112(4 Suppl):291S-295S.
Malignant effusive disease of the pleura and pericardium.
DeCamp MM Jr, Mentzer SJ, Swanson SJ, Sugarbaker DJ.
Division of Thoracic Surgery, Brigham and Women's Hospital, and Harvard
Medical
School, Boston, MA 02115, USA.
Malignant pleural and pericardial effusions are a common problem in the
treatment of patients with lung cancer, breast cancer, or lymphoma and may
occur
with any malignancy. These effusions are frequently symptomatic and, in the
case
of the pleural space, may be the presenting sign of cancer. In other
patients,
they represent markers of recurrent, disseminated, or advanced disease.
Given
the poor prognosis of most patients presenting with these effusions,
reducing
symptoms and improving quality of life are the primary goals of treatment.
Permanent drainage and/or obliteration of the pleural or pericardial space
are
crucial to the effective management of the effusion and will provide
long-term
palliation. Immediate relief can be accomplished via external drainage, but
definitive therapy may often also require interventional radiology,
cardiology,
and thoracic surgery, as well as medical and radiation oncology. The
pathophysiology, diagnosis, and treatment of malignant pleural and
pericardial
effusions are discussed in this article.
Publication Types:
Review
Review, Tutorial
PMID: 9337306 [PubMed - indexed for MEDLINE]
233: Chest. 1997 Oct;112(4 Suppl):239S-241S.
Mediastinoscopy, thoracoscopy, and video-assisted thoracic surgery in the
diagnosis and staging of lung cancer.
Mentzer SJ, Swanson SJ, DeCamp MM, Bueno R, Sugarbaker DJ.
Division of Thoracic Surgery, Brigham and Women's Hospital, and the
Dana-Farber
Cancer Institute, Harvard Medical School, Boston, MA 02115, USA.
The intrathoracic staging of lung cancer involves assessment of the primary
tumor and potential sites of metastases. Imaging studies of the chest are
sensitive in detecting intrathoracic abnormalities, but specific staging
information generally requires a tissue biopsy. The instruments used to
obtain
this information include the bronchoscope, mediastinoscope, and
thoracoscope.
The complementary application of these instruments can provide valuable
staging
information while limiting the morbidity of surgical staging.
Publication Types:
Review
Review, Tutorial
PMID: 9337296 [PubMed - indexed for MEDLINE]
234: Clin Infect Dis. 1997 Sep;25(3):608-13.
Candidal mediastinitis: an emerging clinical entity.
Clancy CJ, Nguyen MH, Morris AJ.
University of Florida College of Medicine and the Veterans Administration
Medical Center, Gainesville 32610, USA.
Candidal mediastinitis is rare. We report nine cases encountered at our
institutions since 1985; seven cases were diagnosed since 1993. All cases
followed thoracic surgery, with a median time from surgery to disease onset
of
11 days (range, 6-100 days). All patients received prior antibiotic therapy.
Common clinical manifestations were chest wall erythema in 4 cases (44%),
drainage in 5 (56%), fever in 4 (44%), and sternal instability in 4 (44%).
Failure to obtain appropriate intraoperative specimens for cultures and the
dismissal of cultures positive for Candida as contaminants delayed diagnosis
in
three cases (33%). Mediastinitis was complicated by contiguous or
hematogenous
spread in seven cases (78%); five patients (56%) had two or more
complications.
The mortality rate was 56%. Optimal therapy remains undefined, but on the
basis
of our experience, aggressive surgical debridement combined with antifungal
therapy for at least 6 weeks is recommended. Prompt recognition and
institution
of therapy appear to be the keys to improving prognosis.
Publication Types:
Case Reports
Review
Review of Reported
Cases
PMID: 9314447 [PubMed - indexed for MEDLINE]
235: Ann Thorac Surg. 1997 Sep;64(3):913-6.
Comment on:
Ann Thorac Surg.
1997 Sep;64(3):908-12.
Is retrograde cerebral perfusion an effective means of neural support during
deep
hypothermic circulatory arrest?
Griepp RB, Juvonen T, Griepp EB, McCollough JN, Ergin MA.
Department of Cardiothoracic Surgery, Mount Sinai School of Medicine, New
York,
New York 10029, USA.
Publication Types:
Comment
Review
Review, Tutorial
PMID: 9307519 [PubMed - indexed for MEDLINE]
236: Ann Thorac Surg. 1997 Sep;64(3):908-12.
Comment in:
Ann Thorac Surg.
1997 Sep;64(3):913-6.
Retrograde cerebral perfusion is an effective means of neural support during
deep
hypothermic circulatory arrest.
Coselli JS.
Methodist Hospital, Baylor College of Medicine, Houston, Texas 77030, USA.
With the current available information, the use of RCP for cerebral
protection
during HCA in the clinical setting will continue to be debated. Laboratory
evaluation in a variety of animal models has thus far produced conflicting
results and a variety of mixed information. Accumulating clinical evidence
has
confirmed that RCP is safe, provided flow rates and central venous
(intracerebral) pressures are maintained at relatively low levels. The use
of
RCP is clinically safe and does not incur additional expense. In the event
that
the only clinical benefits of RCP are the maintenance of cerebral
hypothermia
and the flushing of air and particulate debris from the arterial
circulation,
consequently reducing the risk of embolism, then the continued use and
investigation of RCP techniques is justified.
Publication Types:
Review
Review, Tutorial
PMID: 9307518 [PubMed - indexed for MEDLINE]
237: Can J Anaesth. 1997 Sep;44(9):973-88.
Inhaled nitric oxide: clinical applications, indications, and toxicology.
Troncy E, Francoeur M, Blaise G.
Department of Anaesthesia, Centre Hospitalier de l'Universite de
Montreal-Pavillon Notre-Dame, Quebec, Canada.
PURPOSE: Although the analogy of nitric oxide (NO) to Endothelium-derived
Relaxing Factor remains controversial, medical use of exogenous NO gas by
inhalation has grown exponentially. This review presents the mechanisms of
action of inhaled NO in pulmonary hypertension, hypoxaemia, inflammation and
oedema, as well as its therapeutic and diagnostic indications with emphasis
on
acute respiratory distress syndrome (ARDS) and toxicology. SOURCE: Two
medical
databases (Current Contents, Medline) were searched for citations containing
the
above-mentioned key words to December 1996. Moreover, many presentations in
congresses such as 4th International Meeting of Biology of Nitric Oxide,
52nd
and 53rd Annual Meeting of Canadian Anaesthetists' Society or 10th Annual
Meeting of European Association of Cardiothoracic Anaesthesiologists were
used.
PRINCIPAL FINDINGS: Inhaled NO is now recognized as an invaluable tool in
neonatal and paediatric critical care, and for heart/lung surgery. Other
clinical applications in adults, such as chronic obstructive pulmonary
disease
and ARDS, require a cautious approach. The inhaled NO therapy is fairly
inexpensive, but it would seem that it is not indicated for everybody with
regards to the paradigm of its efficiency and potential toxicity. The recent
discovery of its anti-inflammatory and extrapulmonary effects open new
horizons
for future applications. CONCLUSION: Clinical use of inhaled NO was mostly
reported in case series, properly designed clinical trials must now be
performed
to establish its real therapeutic role. These trials would permit adequate
selection of the cardiopulmonary disorders, and subsequently the patients
that
would maximally benefit from inhaled NO therapy.
Publication Types:
Review
Review, Tutorial
PMID: 9305562 [PubMed - indexed for MEDLINE]
238: Chest Surg Clin N Am. 1997 Aug;7(3):613-22.
Pitfalls and complications of left thoracoabdominal esophagectomy.
Kirby TJ.
Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic
Foundation,
Ohio, USA.
The left thoracoabdominal incision is an excellent option for approaching a
variety of diseases in the lower esophagus and upper abdomen. If attention
is
paid to a few minor details, the incision can be placed properly and closed
with
minimal morbidity as a result of the incision itself. Routine placement of
an
epidural catheter is mandatory and allows early extubation, chest
physiotherapy,
and mobilization.
Publication Types:
Review
Review, Tutorial
PMID: 9246406 [PubMed - indexed for MEDLINE]
239: Curr Opin Pulm Med. 1997 Jul;3(4):319-25.
Current trends in pleurodesis.
Rodriguez-Panadero F.
El Mirador, Tomares, Sevilla, Spain.
Pleurodesis is intended to prevent the accumulation of fluid or air in the
pleural space by creating symphysis between the visceral and parietal
pleura.
The main indications for this procedure are malignant effusions and
pneumothorax. A reexpandable lung and reasonably long expected survival are
criteria that must be met before pleurodesis is attempted in a patient with
malignant pleural effusion. A low pleural fluid pH (less than 7.20) is a
good
predictor for both the presence of a trapped lung and short expected
survival.
Talc appears to be the sclerosing agent of choice in cases of cancer,
whereas
video-assisted thoracic surgery techniques are preferable for the treatment
of
pneumothorax, especially in young patients. To improve results and prevent
complications, application of the right technique is crucial, especially
with
regard to size of drainage and rate of suction. In addition, recent research
suggests that prevention of a systemic activation of coagulation with
prophylactic heparin should be taken into account in patients who are
undergoing
pleurodesis for palliative treatment of malignant effusion.
Publication Types:
Review
Review, Tutorial
PMID: 9262121 [PubMed - indexed for MEDLINE]
240: Monaldi Arch Chest Dis. 1997 Jun;52(3):237-41.
The current role of invasive staging in lung cancer.
Van Schil P, Van den Brande F.
Dept of Surgery, University Hospital of Antwerp, Edegem, Belgium.
Precise mediastinal lymph node staging in otherwise operable non-small cell
lung
cancer (NSCLC) is imperative as it determines subsequent treatment and
prognosis. For mediastinal staging, even present-day computed tomography
(CT)
scanners have a low accuracy, and routine cervical mediastinoscopy is
advised
for precise lymph node assessment, certainly when considering a neoadjuvant
protocol. Cervical mediastinoscopy remains the gold standard, and sampling
of
subcarinal nodes is essential. The role of remediastinoscopy after induction
chemo- or radiotherapy remains to be determined. Extended mediastinoscopy is
indicated to take biopsies of scalene lymph nodes or aorto-pulmonary nodes,
which can also be reached by anterior mediastinoscopy. Video-assisted
thoracic
surgery (VATS) does not replace cervical mediastinoscopy but is a valid
alternative to anterior or extended mediastinoscopy. A more complete
exploration
of the ipsilateral hemithorax is possible, with biopsies of aortopulmonary
and
inferior mediastinal nodes and judgment about resectability of the primary
tumour.
Publication Types:
Review
Review, Tutorial
PMID: 9270250 [PubMed - indexed for MEDLINE]
241: Hematol Oncol Clin North Am. 1997 Jun;11(3):435-47.
Mediastinoscopy, thoracoscopy, and video-assisted thoracic surgery in the
diagnosis and staging of lung cancer.
Mentzer SJ.
Division of Thoracic Surgery, Brigham and Women's Hospital, Boston,
Massachusetts, USA.
The surgical approach to the diagnosis and staging of lung cancer requires
the
assessment of the lung parenchyma, hilum, pleura, chest wall, and
intrathoracic
lymph nodes. Chest computerized tomography is sensitive in defining the
location
of the primary tumor, but is relatively insensitive to invasion. Similarly,
radiographic imaging can identify lymph node enlargement, but lymph node
enlargement alone is insufficient for accurate staging. To facilitate the
tissue
biopsies of both the primary tumor and potential sites of metastatic
disease,
video thoracoscopy has provided a useful complement to traditional
bronchoscopy
and mediastinoscopy. These instruments provide minimally invasive access to
the
lung, pleura, and ipsilateral lymph nodes. The combined application of
thoracoscopy, bronchoscopy, and mediastinoscopy can provide intrathoracic
staging information while minimizing surgical morbidity.
Publication Types:
Review
Review, Tutorial
PMID: 9209904 [PubMed - indexed for MEDLINE]
242: World J Surg. 1997 Jun;21(5):475-9.
Surgical indications for treatment of pulmonary tuberculosis.
Freixinet J.
Thoracic Surgery Service, University Hospital Ntra. Sra. del Pino, Las
Palmas de
Gran Canaria, Canary Islands, Spain.
Surgery for pulmonary tuberculosis (PTB) has passed through various stages
throughout history, having been the treatment of choice in the past. It has
now
been relegated to second place for treatment of this disease. One of the
most
strongly debated surgical indications has been clinical picture of multidrug
resistance with the focus of pulmonary tuberculous activity located in a
segment, lobe, or lung. In these cases some authors have described good
results
with surgical excision. Another important indication is the complications of
PTB, among which bronchiectases (provoking pictures of suppuration,
superinfections, or hemoptysis) are found, along with known destructive
pulmonary sequelae such as destroyed lung, massive hemoptysis, and the
presence
of a bronchopleural fistula that cannot be resolved with pleural drainage.
The
presence of a neoplasm in a patient affected by PTB is a surgical indication
if
the lesion is resectable. The existence of an unidentifiable pulmonary mass
or
node is a surgical criterion because it might signal bronchogenic carcinoma.
A
frequent indication for surgery is pulmonary aspergilloma, which in a large
percentage of cases is a destructive PTB sequela and generates serious
complications, hemoptysis being the most frequent. Mediastinal tuberculous
lymphadenitis that produces compressive symptoms and pulmonary
complications,
especially in children, is another surgical indication for decompressing the
bronchial tree. The surgery in these cases consists in excision and
curettage of
adenopathies. Surgery therefore now constitutes a valid option for the
treatment
of certain clinical pictures of PTB that do not respond to medical
treatment,
are serious, and are potentially fatal.
Publication Types:
Review
Review, Tutorial
PMID: 9204733 [PubMed - indexed for MEDLINE]
243: N Engl J Med. 1997 May 15;336(20):1429-34.
Erratum in:
N Engl J Med 1997
Jul 17;337(3):209.
Comment in:
N Engl J Med. 1997
Sep 18;337(12):860-1; author reply 861.
N Engl J Med. 1997
Sep 18;337(12):861.
Atrial arrhythmias after cardiothoracic surgery.
Ommen SR, Odell JA, Stanton MS.
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA.
Publication Types:
Review
Review, Tutorial
PMID: 9145681 [PubMed - indexed for MEDLINE]
244: J Wound Care. 1997 May;6(5):240-3.
Resection and reconstruction of the chest wall.
Hurren J, Heriot AG, Wells FC, Lamberty BG.
Addenbrooke's NHS Trust, Cambridge.
Publication Types:
Review
Review, Tutorial
PMID: 9256732 [PubMed - indexed for MEDLINE]
245: J Clin Nurs. 1997 May;6(3):215-25.
Underwater seal chest drains: the patient's experience.
Owen S, Gould D.
King's College, London, UK.
Chest drains are routinely inserted during thoracic surgery and to
conservatively manage spontaneous pneumothorax. An extensive search of the
literature revealed only a small number of highly prescriptive articles to
advise the nurse on the specific care needs of this patient group. An
exploratory study undertaken with 18 patients drew attention to the
persistent
discomfort and pain experienced by patients throughout the entire time that
the
chest drain remained in situ. Most of the patients also experienced
short-lasting but intense pain when the chest drain was removed. Patients
appeared ill-prepared for their experiences despite opportunities to obtain
verbal and written information from staff.
Publication Types:
Review
Review Literature
PMID: 9188339 [PubMed - indexed for MEDLINE]
246: J Trauma. 1997 Apr;42(4):670-4.
Video-assisted thoracic surgery in treatment of chest trauma.
Liu DW, Liu HP, Lin PJ, Chang CH.
Department of Thoracic and Cardiovascular Surgery, Chang Gung Memorial
Hospital,
Chang Gung Medical College, Taipei, Taiwan, Republic of China.
Although the indications for video-assisted thoracic surgery (VATS) have
expanded rapidly, especially in the areas of therapeutic and operative
procedures, its role in the definite surgical treatment of chest trauma is
not
clear. From July 1994 to December 1995, 56 patients with hemothorax or
posthemothorax complications resulting from chest trauma received thoracic
surgery. Their ages ranged from 17 to 71 years. Mechanisms of injury
included
penetrating (n = 23) and blunt injury (n = 33). VATS was successfully
applied in
50 patients; six patients with cardiovascular injuries (n = 4) or minor
chest
wall lacerations (n = 2) did not receive VATS. All patients who received
VATS
survived, with no morbidity. Twelve of the 50 patients treated with VATS
would
have otherwise had to undergo thoracotomy. Our results indicate that VATS
can be
safely used in hemodynamically stable patients with no cardiovascular or
great
vessel injury, sparing many patients the pain and morbidity associated with
thoracotomy. Additionally, use of VATS may reduce the likelihood of
posthemothorax complications by allowing early direct inspection of the
chest
wall, because VATS has a lower associated risk and can be performed with a
lower
index of suspicion than can standard thoracotomy.
Publication Types:
Review
Review, Tutorial
PMID: 9137256 [PubMed - indexed for MEDLINE]
247: Br J Hosp Med. 1997 Mar 19-Apr 1;57(6):255-9.
Chest wall resection and reconstruction.
Sabanathan S, Shah R, Mearns AJ, Richardson J.
Department of Thoracic Surgery and Anaesthesia, Bradford Royal Infirmary.
Chest wall reconstruction may be required after resection of malignant
tumours,
radiation injuries, massive trauma or infection. The ideal reconstruction
should
provide enough stability in the chest wall to allow adequate, spontaneous
ventilation, while protecting intrathoracic organs, and be cosmetically
acceptable. Recent developments have enabled the reconstruction of defects
of
almost any size with minimal functional disturbance.
Publication Types:
Review
Review, Tutorial
PMID: 9196567 [PubMed - indexed for MEDLINE]
248: J Am Coll Surg. 1997 Mar;184(3):316-24.
Comment in:
J Am Coll Surg.
1997 Aug;185(2):197-8.
Video-assisted thoracic surgery in trauma patients.
Carrillo EH, Heniford BT, Etoch SW, Polk HC Jr, Miller DL, Miller FB,
Richardson
JD.
Department of Surgery, University of Louisville School of Medicine, Ky
40292,
USA.
Publication Types:
Review
Review, Tutorial
PMID: 9060933 [PubMed - indexed for MEDLINE]
249: Elder Care. 1997 Feb-Mar;9(1):20, 22.
Healing cavity wounds with negative pressure.
Baxandall T.
Harefield Hospital, Middlesex.
Publication Types:
Case Reports
Review
Review, Tutorial
PMID: 9180449 [PubMed - indexed for MEDLINE]
250: J Am Coll Surg. 1997 Feb;184(2):196-203.
What's new in general thoracic surgery.
Patterson GA.
Washington University, St. Louis, Mo, USA.
Publication Types:
Review
Review, Tutorial
PMID: 9022640 [PubMed - indexed for MEDLINE]
251: Annu Rev Med. 1997;48:387-98.
Recent advances in surgery for emphysema.
Lefrak SS, Yusen RD, Trulock EP, Pohl MS, Patterson A, Cooper JD.
Division of Pulmonary and Critical Care Medicine, Washington University
School
of Medicine, St. Louis, Missouri 63310, USA.
Volume reduction surgery is based on the removal of volume-occupying but
nonfunctioning emphysematous lung, which is thought to improve pulmonary
elastic
recoil. The reduction in thoracic volume may also improve thoracic cage and
inspiratory muscle function. In addition, dyspnea is lessened, exercise
tolerance is increased, and measured pulmonary function is improved.
Alveolar
gas exchange may also be improved. Selection criteria include marked airway
obstruction secondary to emphysema, marked hyperinflation of the chest wall,
and
regional heterogeneity in the distribution of the emphysema. The best
results
are obtained with a bilateral procedure utilizing stapling resection. The
two
surgical approaches are median sternotomy and video-assisted thoracic
surgery.
Publication Types:
Review
Review, Tutorial
PMID: 9046970 [PubMed - indexed for MEDLINE]
252: Surg Laparosc Endosc. 1996 Dec;6(6):476-9.
Lobectomy by video-assisted thoracic surgery for a hilar bronchial carcinoid
tumor.
Watanabe M, Ono K, Sato M, Deguchi H, Tsumatori G, Aoki T, Takagi K, Tanaka
S.
Department of Surgery II, National Defense Medical College, Saitama, Japan.
A 45-year-old man with bronchial carcinoid arising from the subsegmental
middle-lobe bronchus was treated by video-assisted thoracic surgery.
Lobectomy
with mediastinal and hilar lymph node sampling was successfully performed in
this patient. To obtain a tumor-free surgical margin on the middle-lobe
bronchus, the interlobar pulmonary artery was retracted posteriorly, the
middle-lobe bronchus anteriorly. The bronchus was then stapled and
transected.
Publication Types:
Case Reports
Review
Review of Reported
Cases
PMID: 8948042 [PubMed - indexed for MEDLINE]
253: Artif Organs. 1996 Dec;20(12):1295-8.
Using titanium plate or meshplate for chest wall reconstruction: report of 6
cases and literature review.
Luh SP, Lee YC, Lee JM, Lee CJ.
Department of surgery, College of Medicine, National Taiwan University,
Taipei,
Republic of China.
Titanium plate has been widely used in several surgical fields, such as
craniofacial reconstruction and orthopedic prosthesis. This prosthesis has
been
proved not only with good biocompatibility and mechanical strength, but also
with light weight and low radiological interference. From October 1991 to
May
1995, 6 patients underwent thoracic cage reconstruction with titanium plate
in
our hospital. They included 5 females and 1 male, with ages ranging from 26
to
62 years. Four of them suffered from primary chest wall tumors (2 desmoid
tumors, a chondrosarcoma, and 1 hemangioma), one had a recurrent chest wall
tumor from breast carcinoma, and one had thoracic hypoplasia. The thoracic
cage
defect ranged from 5 x 6 cm to 10 x 15 cm, and 1 to 3 titanium plates were
used
for the reconstruction. No paradoxical movement or other prosthesis-related
complications have occurred during the follow-up period. We conclude that
titanium plate is a good material for thoracic cage reconstruction.
Publication Types:
Case Reports
Review
Review of Reported
Cases
PMID: 8947451 [PubMed - indexed for MEDLINE]
254: Chest Surg Clin N Am. 1996 Nov;6(4):875-98.
Tracheal tumors.
Mathisen DJ.
Department of General Thoracic Surgery, Massachusetts General Hospital,
Boston,
USA.
Tumors of the airway can be classified into malignant (squamous and
adenoidcystic) and low-grade or benign neoplasms. The most common tumors are
squamous cancer and adenoidcystic, occurring in about equal numbers. Pre-
and
intraoperative evaluations are mandatory, along with strict attention to
technical details and postoperative care. Both squamous cancers and
adenoidcystic cancers should be treated with postoperative irradiation.
Successfully removed benign tumors do not require additional therapy and are
almost always cured by resection and reconstruction.
Publication Types:
Review
Review, Tutorial
PMID: 8934015 [PubMed - indexed for MEDLINE]
255: Chest Surg Clin N Am. 1996 Nov;6(4):853-64.
Complications of tracheal surgery.
Mathisen DJ.
Department of General Thoracic Surgery, Massachusetts General Hospital,
Boston,
USA.
Complications of tracheal surgery are best managed by avoiding them. This
entails proper patient selection through evaluation; careful coordination
between anesthesia, otolaryngology, and thoracic surgery; meticulous
attention
to the technical details of operation; and postoperative care. There must be
a
firm understanding of airway management in the postoperative period ranging
from
edema, anastomotic granulations, fistula, separation, or recurrent stenosis.
Successful management can be accomplished with preservation of the airway.
Publication Types:
Review
Review, Tutorial
PMID: 8934013 [PubMed - indexed for MEDLINE]
256: Chest Surg Clin N Am. 1996 Nov;6(4):837-52.
Surgical management of congenital tracheal stenosis.
Brown JW, Bando K, Sun K, Turrentine MW.
Section of Cardiothoracic Surgery, Indiana University Medical Center,
Indianapolis, USA.
Long-segment tracheal stenosis in infants and children is difficult to
manage
and can be life-threatening. Patients frequently have associated cardiac,
other
respiratory, or gastrointestinal anomalies that may confuse the diagnosis at
initial presentation. The rarity of congenital tracheal stenosis has not
allowed
sufficient experience for the development of standard treatment protocol.
Several surgical techniques have been described but have varying results.
This
article reviews the diagnosis and different surgical options for congenital
tracheal stenosis and their outcomes.
Publication Types:
Review
Review, Tutorial
PMID: 8934012 [PubMed - indexed for MEDLINE]
257: Chest Surg Clin N Am. 1996 Nov;6(4):811-8.
Management of idiopathic tracheal stenosis.
Grillo HC.
Thoracic Surgical Unit, Massachusetts General Hospital, Boston, USA.
Idiopathic laryngotracheal stenosis usually occurs in women, produces
stenosis
of 1 to 3 cm, is densely collagenous, and is unaccompanied by systemic
disease.
It may be successfully managed by one stage resection and reconstruction,
most
often including a portion of the lower larynx.
Publication Types:
Review
Review, Tutorial
PMID: 8934010 [PubMed - indexed for MEDLINE]
258: Chest Surg Clin N Am. 1996 Nov;6(4):777-90.
Surgical management of thyroid cancer invading the trachea.
Zannini P, Melloni G.
Department of Cardiothoracic Surgery, H. San Raffaele, University of Milan,
Italy.
Airway invasion by thyroid carcinoma is a life-threatening disease and its
severity is emphasized by the high incidence of death by suffocation because
of
bleeding or airway obstruction. A favorable prognosis may be obtained,
however,
with proper treatment of tracheal invasion. The standardization of reliable
techniques for tracheal resection and reconstruction has made radical
surgery a
reasonable therapeutic approach to thyroid carcinomas invading the trachea.
When
the cricoid is invaded by the tumor, partial laryngeal resection becomes
necessary but subsequent airway reconstruction is still possible with
preservation of laryngeal function. Laryngectomy with placement of an end
tracheostomy should be performed only in patients with extensive laryngeal
infiltration. Our personal experience at the University of Milan Medical
School
supports the indications, techniques, and results reported in the literature
and
shows the effectiveness of tracheal resection and reconstruction in the
treatment of infiltrating thyroid carcinoma. Tracheal resection and
reconstruction for invasive thyroid carcinoma prevents death by
asphyxiation,
provides long-lasting palliation with good quality of life, and may even be
curative.
Publication Types:
Review
Review, Tutorial
PMID: 8934008 [PubMed - indexed for MEDLINE]
259: Chest Surg Clin N Am. 1996 Nov;6(4):725-31.
Postintubation tracheal stenosis.
Grillo HC, Donahue DM.
Thoracic Surgical Unit, Harvard Medical School, Boston, Massachusetts, USA.
Resection and reconstruction are the treatments of choice for postintubation
tracheal stenosis, attested to by 94% good or satisfactory results in over
500
patients. Accurate diagnosis, appropriate patient selection, and experienced
and
precise surgical care are important in these treatments.
Publication Types:
Review
Review, Tutorial
PMID: 8934004 [PubMed - indexed for MEDLINE]
260: Chest Surg Clin N Am. 1996 Nov;6(4):693-700.
Pediatric tracheal problems.
Grillo HC.
Thoracic Surgical Unit, Massachusetts General Hospital, Boston, USA.
Awareness of the special problems of airway repair in children and precise
application of principles of tracheal and laryngotracheal surgery are
necessary
for success in treating acquired pediatric airway lesions. Long segment
congenital lesions require special techniques, which are still evolving.
Publication Types:
Review
Review, Tutorial
PMID: 8934002 [PubMed - indexed for MEDLINE]
261: Chest Surg Clin N Am. 1996 Nov;6(4):675-82.
Tracheal release maneuvers.
Heitmiller RF.
Department of Surgery, Johns Hopkins Medical Institutions, Baltimore,
Maryland,
USA.
Tracheal release procedures are specialized surgical techniques designed to
permit low tension end-to-end primary reconstruction after tracheal sleeve
resection. Therefore, an understanding of the principles and techniques of
these
tracheal release maneuvers is essential in order to perform tracheal surgery
safely. The release procedures include dissection of the pretracheal plane,
cervical flexion, and laryngeal and hilar release. Dissection of the
pretracheal
plane and cervical flexion are the most commonly employed techniques.
Publication Types:
Review
Review, Tutorial
PMID: 8934000 [PubMed - indexed for MEDLINE]
262: Postgrad Med. 1996 Nov;100(5):241-4, 247-8, 251-2 passim.
Preoperative pulmonary evaluation. Identifying patients at increased risk
for
complications.
Mohr DN, Lavender RC.
Mayo Medical School, Rochester, Minnesota. dmohr@mayo.edu
During surgical procedures, multiple physiologic changes affect the
pulmonary
system and its defense mechanisms. The presence of basic risk factors (eg,
smoking, chronic obstructive pulmonary disease, severe obesity) can affect
whether these physiologic changes result in pulmonary complications or even
death. Therefore, the presence of risk factors should be ascertained in all
patients before abdominal or thoracic surgery. The degree of risk can be
further
determined preoperatively by additional evaluation, such as pulmonary
function
testing, newer assessment of cardiorespiratory status, history taking, and
physical examination. The presence of risk factors and the type of operation
to
be performed should guide decisions about whether to perform a procedure or
to
use prophylactic measures before and after surgery. New operative techniques
may
allow some procedures that were prohibited in the past to be performed in
high-risk patients.
Publication Types:
Review
Review, Tutorial
PMID: 8917336 [PubMed - indexed for MEDLINE]
263: Int Surg. 1996 Oct-Dec;81(4):343-6.
Video-assisted thoracic surgery (VATS) for cancer. Risk of parietal seeding
and
of early local recurrence.
Collard JM, Reymond MA.
Louvain Medical School, Brussels, Belgium.
Both parietal seeding and early local recurrence have been anecdotally (24
cases) reported in the surgical literature after video-assisted thoracic
surgery
(VATS) for cancer. However, not all the cases reported were undoubtedly
related
to the thoracoscopic approach itself, several of those thoracoscopic
procedures
addressed locally advanced neoplastic processes, and protective measures
against
parietal contamination were not taken in one half of the patients. Strict
adherence to the classic principles of carcinologic surgery should minimize
the
risk of both parietal and pleural grafting after VATS for cancer.
Publication Types:
Review
Review, Tutorial
PMID: 9127791 [PubMed - indexed for MEDLINE]
264: J Hypertens Suppl. 1996 Oct;14(3):S3-9.
Clinical pharmacology of calcium antagonists as antihypertensive and
anti-anginal drugs.
van Zwieten PA.
Department of Pharmacotherapy, University of Amsterdam, The Netherlands.
USE OF CALCIUM ANTAGONISTS: These drugs are prescribed for antihypertensive
activity in patients with essential hypertension, perioperative hypertension
associated with thoracic surgery, angina pectoris and for secondary
prevention
after acute coronary syndromes (myocardial infarction, unstable angina).
ACTION
OF NEWER CALCIUM ANTAGONISTS: Pharmacokinetic improvements to the original
calcium antagonists have provided slow- and long-acting drugs in the
dihydropyridine group, which provoke little or no reflex tachycardia.
Vasoselectivity (to a certain degree) is another improvement in a few newer
compounds. Some may even have a certain selectivity for particular,
specialized
vascular beds. SAFETY: At present it seems preferable to use the newer slow-
and
long-acting dihydropyridine calcium antagonists. Their long-term safety is
the
subject of ongoing, randomized prospective trials.
Publication Types:
Review
Review, Tutorial
PMID: 9120664 [PubMed - indexed for MEDLINE]
265: Eur J Surg. 1996 Oct;162(10):757-62.
Oesophageal surgery: review of its history illustrated by the practice of a
single hospital.
Zilling TL.
Department of Surgery, Lund University Hospital, Sweden.
Publication Types:
Historical Article
Review
Review, Tutorial
PMID: 8934103 [PubMed - indexed for MEDLINE]
266: Thorax. 1996 Aug;51 Suppl 2:S23-8.
Video assisted thoracic surgery for spontaneous pneumothorax.
Berrisford RG, Page RD.
Cardiothoracic Centre, Liverpool, UK.
Publication Types:
Review
Review, Tutorial
PMID: 8869348 [PubMed - indexed for MEDLINE]
267: Chest Surg Clin N Am. 1996 Aug;6(3):567-83.
Fibrin sealant in thoracic surgery. Pulmonary applications, including
management
of bronchopleural fistula.
Bayfield MS, Spotnitz WD.
Department of Surgery, University of Virginia, Charlottesville, USA.
This article characterizes the pulmonary surgical applications of fibrin
sealant. It discusses the current uses of fibrin sealant in pulmonary
operations; summarizes the available methods of fibrin sealant production;
reviews the commercial availability of fibrin sealant compounds; and
elaborates
on future developments for fibrin sealant in the United States.
Publication Types:
Review
Review, Tutorial
PMID: 8818422 [PubMed - indexed for MEDLINE]
268: Chest Surg Clin N Am. 1996 Aug;6(3):501-18.
Intrathoracic muscle transposition. Surgical anatomy and techniques of
harvest.
Harris SU, Nahai F.
Division of Plastic and Reconstructive Surgery, Emory, University School of
Medicine, Atlanta, Georgia, USA.
The transposition of extrathoracic muscle and soft tissue to the thoracic
cavity
is well established in the treatment of various congenital and acquired
thoracic
conditions. Precise understanding of the surgical anatomy of these
muscles/soft
tissues is vital to the safe and effective utilization of these techniques.
Their use follows the basic surgical principles of tissue repair without
tension, filling dead space, and using well-vascularized tissues for
surgical
closures. Close cooperation between the thoracic surgeon and the plastic
surgeon
is vital in the treatment of these difficult, and sometimes
life-threatening,
situations.
Publication Types:
Review
Review, Tutorial
PMID: 8818418 [PubMed - indexed for MEDLINE]
269: Chest Surg Clin N Am. 1996 Aug;6(3):461-90.
Decortication in thoracic empyema. Indications and surgical technique.
Thurer RJ.
Division of Cardiothoracic Surgery, University of Miami School of Medicine,
Florida, USA.
Decortication for empyema is a well-established procedure and is based on
sound
surgical principles. When applied in properly selected patients, rapid
recovery
with a good functional result is to be expected. Best results are obtained
when
the optimal time for surgical intervention is chosen, usually relatively
early
in the course of the process for which it is employed. Although modern
supportive care and antibiotic therapy are important, a properly performed
operation, employed at the proper time, is a major determinant of a successful
outcome.
Publication Types:
Historical Article
Review
Review, Tutorial
PMID: 8818416 [PubMed - indexed for MEDLINE]
270: Chest Surg Clin N Am. 1996 Aug;6(3):419-38.
Current diagnostic methods and medical management of thoracic empyemas.
Lee-Chiong TL Jr, Matthay RA.
Intensive Care Unit, Cardiopulmonary Services, Androscoggin Valley Hospital,
Berlin, New Hampshire, USA.
Infections can invade the normally sterile pleural space leading to the
development of parapneumonia effusions or empyemas. Pneumonia, thoracic
surgery,
and trauma, together, are responsible for most cases of empyemas.
Pneumococci
and staphylococci remain the predominant etiologic organisms. In addition,
gram-negative aerobic bacteria and anaerobes are emerging as important
pathogens. Most parapneumonic pleural effusions, regardless of their
underlying
etiology and bacteriology, evolve through definable stages. For each stage
of
the disease, specific therapeutic measures, either medical or surgical, are
available.
Publication Types:
Review
Review, Tutorial
PMID: 8818414 [PubMed - indexed for MEDLINE]
271: Semin Thorac Cardiovasc Surg. 1996 Jul;8(3):277-85.
Pediatric lung transplantation: indications and contraindications.
Kurland G.
Division of Pediatric Pulmonology, University of Pittsburgh School of
Medicine,
PA 15213, USA.
As the practice of lung transplantation in children evolves, the indications
are
expanding. The major diagnostic groups for which transplantation is offered
are
similar to those used in adult lung transplantation with the notable absence
of
obstructive lung disease. Of all children under the age of 18 years
undergoing
lung transplantation, cystic fibrosis accounts for approximately 35%,
pulmonary
vascular disease, with or without associated congenital heart disease,
accounts
for 25-30%, and interstitial lung diseases comprise about 10%. The other
categories included retransplantation and a variety of diagnoses which by
themselves describe an unusual form of end-stage pulmonary disease. The
selection of candidates with transplantable diagnoses is crucial, and as
this
specialty evolves the contraindications have as well. Colonization of the
airway
with resistant bacterial or fungal organisms, history of multiple prior
thoracic
procedures, need for mechanical ventilation, diabetes mellitus, and the
presence
of other organ failure constitute some relative contraindications for
transplantation. Retransplantation is a controversial issue that has not yet
been resolved.
Publication Types:
Review
Review, Tutorial
PMID: 8843520 [PubMed - indexed for MEDLINE]
272: Ann Thorac Surg. 1996 Jun;61(6):1856-64.
Comment in:
Ann Thorac Surg.
1997 Jan;63(1):298-9.
Inhaled nitric oxide: therapeutic applications in cardiothoracic surgery.
Fullerton DA, McIntyre RC Jr.
Department of Surgery, University of Colorado, Denver, USA.
Hypoxemia and increased pulmonary vascular resistance can greatly complicate
the
management of cardiothoracic surgical patients. These complications are
commonly
found in the setting of thoracic organ transplantation, adult and pediatric
cardiac surgical procedures, and general thoracic surgical procedures.
Inhaled
nitric oxide is a new therapy that promises to be extremely valuable to the
cardiothoracic surgeon. It has been shown to improve oxygenation in the
setting
of acute lung injury and to selectively lower pulmonary vascular resistance,
without producing unwanted systemic vasodilation. The purpose of this review
is
to discuss the biochemistry, toxicity, experimental studies, and therapeutic
applications of inhaled nitric oxide administration in cardiothoracic
surgical
patients.
Publication Types:
Review
Review, Tutorial
PMID: 8651811 [PubMed - indexed for MEDLINE]
273: Chest Surg Clin N Am. 1996 May;6(2):329-47.
The use of fiberoptic endoscopy in anesthesia.
Lee AC, Wu CL, Feins RH, Ward DS.
Department of Anesthesiology, University of Rochester Medical Center, New
York,
USA.
The fiberoptic bronchoscope has contributed greatly to the practice of
anesthesiology over the past 30 years. It has become an indispensable tool
in
the approach to the difficult airway, as well as the placement and
positioning
of double-lumen tubes for thoracic surgery. The equipment, preparation, and
methods for using the endoscope in anesthesia, are presented here.
Publication Types:
Review
Review, Tutorial
PMID: 8724282 [PubMed - indexed for MEDLINE]
274: Semin Thorac Cardiovasc Surg. 1996 Apr;8(2):221-8.
Results of the surgical treatment for thoracic outlet syndrome.
Sanders RJ.
Department of Surgery, Rose Medical Center, Denver, CO, USA.
Excellent and good results following different operations for TOS are close
to
80%, using simple statistics, where results included many patients followed
up
for only a few months. Using life-table methods, the success rate is 6% to
9%
less, close to 70%, at 5 years. The results were virtually identical for
anterior and middle scalenectomy, transaxillary first rib resection, and
combined supraclavicular scalenectomy and first rib resection. Secondary
success, the results of reoperation on patients in whom the first operation
failed, improved the results of the primary operation 15% and 17%,
respectively,
for transaxillary rib resection and anterior and middle scalenectomy. When
the
initial operation was combined rib resection and scalenectomy, fewer
patients
underwent reoperation, as only neurolysis could be performed, and the
results
improved only 3%. A significant variable in results was etiology:
Work-related
injuries versus non-work-related accidents, usually auto accidents. Results
of
three independent studies showed better success rates by 13% to 15%, in
patients
who had non-work-related auto accidents, as compared with work-related
injuries.
Publication Types:
Review
Review, Tutorial
PMID: 8672577 [PubMed - indexed for MEDLINE]
275: Semin Thorac Cardiovasc Surg. 1996 Apr;8(2):176-82.
Thoracic outlet syndrome: a current overview.
Mackinnon SE, Patterson GA, Novak CB.
Department of Surgery, Washington University School of Medicine, St. Louis,
MO,
USA.
Thoracic outlet syndrome and the surgery associated with this diagnosis have
a
controversial reputation. The majority of patients with thoracic outlet
syndrome
seen in the context of the work place will have a multiplicity of components
to
their symptomatology, including multilevel nerve compression and muscle
imbalance of the neck, shoulder, and back. Identification and conservative
management of these problems make the necessity for surgery for thoracic
outlet
syndrome a rare event. Decompression of the brachial plexus, with or without
first rib resection, is a technically demanding surgical procedure requiring
expertise in peripheral nerve, vascular and thoracic surgery. Evaluation of
these patients requires an understanding of neuromuscular physiology and
chronic
pain syndromes.
Publication Types:
Review
Review, Tutorial
PMID: 8672571 [PubMed - indexed for MEDLINE]
276: Chest Surg Clin N Am. 1996 Feb;6(1):41-52.
Thoracoscopic resection of mediastinal tumors and the thymus.
Kaiser LR.
Department of Surgery, Hospital of the University of Pennsylvania,
University of
Pennsylvania School of Medicine, Philadelphia, USA.
Videothoracoscopic techniques have proven their usefulness in dealing with
pathology in the anterior mediastinum and should be considered in many cases
as
the procedure of choice. The surgeon's judgment, as always, is key in
deciding
which procedure is best suited for dealing with a particular lesion in any
given
patient. Thoracic surgeons need to be facile with these techniques in order
to
be able to provide the best approach for each patient. We need to be
vigilant in
observing and reporting results with these still relatively new procedures
to
ensure that outcomes are equivalent to the standard open procedures. The
cost
effectiveness of these minimally invasive procedures compared with the
analogous
open procedure still remains to be determined. Despite a shortened hospital
stay
for many of these procedures the equipment is more expensive and time in the
operating room may be longer. It is safe to say, however, that many of these
minimally invasive procedures are here to stay even if they fail to show a
reduction in costs.
Publication Types:
Review
Review, Tutorial
PMID: 8646503 [PubMed - indexed for MEDLINE]
277: Chest Surg Clin N Am. 1996 Feb;6(1):149-56.
Transverse sternothoracotomy.
Wright C.
General Thoracic Surgical Unit, Massachusetts General Hospital, Boston, USA.
Transverse sternothoracotomy (the clamshell incision) has been resurrected
from
the early days of cardiac surgery and is now used for double lung
transplantation, bilateral pulmonary tumors, and selected mediastinal
tumors.
Bulky mediastinal tumors that project into the pleural space are exposed
well
with this incision.
Publication Types:
Review
Review, Tutorial
PMID: 8646500 [PubMed - indexed for MEDLINE]
278: Chest Surg Clin N Am. 1996 Feb;6(1):117-38.
Open approaches to posterior mediastinal tumors and the spine.
Thurer RJ, Herskowitz K.
Division of Cardiothoracic Surgery, University of Miami School of Medicine,
Florida, USA.
Open operations continue to be the appropriate approach in the diagnosis and
treatment of many posterior mediastinal lesions. Transthoracic approach to
the
spine is required for appropriate access to allow complex reconstructive
procedures to be done. The surgeon must be aware of the anatomic details of
the
region to avoid disabling neurologic injuries and allow precise and
appropriate
surgical management. Thoracoscopic approaches are now being used in some
situations. The role of open and thoracoscopic techniques in the treatment
of
mediastinal and spinal problems will certainly continue to evolve as
experience
with newer techniques increases.
Publication Types:
Review
Review, Tutorial
PMID: 8646498 [PubMed - indexed for MEDLINE]
279: Acta Chir Belg. 1996 Feb;96(1):23-7.
Role of thoracoscopy (VATS) in pleural and pulmonary pathology.
Van Schil P, Van Meerbeeck J, Vanmaele R, Eyskens E.
Department of Surgery, University Hospital of Antwerp, Edegem, Belgium.
Although thoracoscopy is not a new procedure, there was a real revival after
the
introduction of laparoscopy. VATS (video-assisted thoracic surgery) has
potential advantages of reduced pain due to smaller incisions and a shorter
hospital stay. Main disadvantages are expensive equipment and a probably
less
adequate operation, especially for therapy of malignant disorders where
long-term results are not known. VATS is very useful for investigation of
pleural effusion and malignancy. Spontaneous pneumothorax is a very good
indication for thoracoscopic treatment, as well as lung biopsy and
diagnostic
resection of lung metastases. Therapeutic metastasectomy, however, should
not be
performed by VATS. Regarding bronchogenic carcinoma, VATS is indicated for
staging of lung cancer, facilitating sampling of mediastinal and hilar lymph
nodes, investigation of pleural effusion, possible pleural dissemination and
suspicion of intrapulmonary metastases. Wedge excision of solitary pulmonary
nodules by VATS readily reveals the exact diagnosis, but its role in therapy
of
lung cancer is very limited at the present time.
Publication Types:
Review
Review, Tutorial
PMID: 8629383 [PubMed - indexed for MEDLINE]
280: J Am Coll Surg. 1996 Feb;182(2):162-9.
What's new in general thoracic surgery.
Miller JI Jr.
Division of Cardiothoracic Surgery, Emory University School of Medicine,
Atlanta, GA 30308, USA.
Publication Types:
Review
Review, Tutorial
PMID: 8564049 [PubMed - indexed for MEDLINE]
281: Eur J Cardiothorac Surg. 1996;10(9):727-33.
Controlled clinical studies of fibrin sealant in cardiothoracic surgery--a
review.
Kjaergard HK, Fairbrother JE.
Department of Cardiothoracic Surgery, Gentofte University Hospital,
Hellerup,
Denmark.
OBJECTIVE: More than 2300 clinical papers have been published on the
surgical
applications of fibrin sealant (FS), with the largest number in the
speciality
of cardiothoracic surgery. The purpose of this review of the literature was
to
find and evaluate controlled studies published in the field of
cardiothoracic
surgery, to clarify the indications and emphasize the benefits of FS
available
to the practising surgeon. METHODS: A database of the surgical publications
of
FS was created. Up to the end of 1995, at least 24 controlled clinical
studies
had been published; these may be divided into 20 studies with a positive
outcome
and 4 studies where the results were not different from the controls. In
none of
the studies was the clinical result worse after the use of FS. RESULTS: In
most
of the cardiac studies, FS was successfully used at bleeding sites in
reoperations and in congenital heart surgery. Postoperative bleeding may
also be
reduced by the anterior mediastinal spray application of FS or by preparing
woven Dacron prostheses with the sealant. In addition, Fs has been found to
improve results after type A aortic disections and, by adding an antibiotic
to
the sealant, the postoperative infection rate for active endocarditis of the
aortic root can be reduced. In pulmonary surgery FS can be used to reduce
pulmonary air leakage, however the results of some studies diverge due to
different clinical test conditions and the inclusion of only a small number
of
patients in the "negative" studies. In none of the controlled
studies of
esophageal surgery could FS prevent leakage from esophageal anastomoses.
CONCLUSIONS: Fibrin sealant is safe when it is applied properly, but there
is a
learning curve for surgeons who start using it. An autologous sealant or a
sealant containing human instead of bovine thrombin is preferred, since
repeated
use of bovine thrombin may induce coagulopthies. The number of controlled
clinical studies of FS is currently increasing, with the majority of the
papers
revealing a beneficial effect of FS when it is used as a hemostatic or
sealing
agent in cardiothoracic surgery.
Publication Types:
Review
Review, Tutorial
PMID: 8905274 [PubMed - indexed for MEDLINE]
282: Neurosurg Clin N Am. 1996 Jan;7(1):87-98.
Percutaneous endoscopic thoracic discectomy.
Regan JJ.
Department of Orthopedic Surgery, University of Texas Southwestern Medical
Center, Dallas, USA.
Video-assisted thoracic surgery (VATS) appears to be a safe and efficacious
method of excising herniated thoracic discs. Results indicate high patient
satisfaction rates comparable to those of open thoracotomy. VATS' advantages
include decreased length of hospitalization, decreased postoperative pain,
less
shoulder girdle dysfunction, lower incidence of pulmonary complications and
post-thoracotomy syndrome, and earlier return to normal activity when
compared
to thoracotomy approaches.
Publication Types:
Review
Review, Tutorial
PMID: 8835149 [PubMed - indexed for MEDLINE]
283: Eur J Cardiothorac Surg. 1996;10(3):161-7.
Video-assisted thoracoscopic pulmonary surgery--current status and potential
evolution.
Walker WS, Craig SR.
Department of Thoracic Surgery, City Hospital, Edinburgh, UK.
The current status of video-assisted thoracoscopic surgery (VATS) of the
lung
has been reviewed. The published data support the view that VATS pulmonary
surgery is feasible and safe. It is associated with decreased perioperative
pain
and opiate requirement, better postoperative pulmonary function, and
probable
overall neutral cost impact. A VATS approach is functionally superior to
open
thoracotomy for wedge resection, pneumothorax surgery and bullous lung
disease
and may allow surgical intervention in patients with pulmonary function
which is
in adequate for open resection. Major VATS pulmonary resection with
lobectomy
and pneumonectomy can be performed for early malignant disease without
compromising established surgical principles. Specific training is needed in
VATS surgery and background skills in general thoracic surgery are necessary
to
underwrite major interventions. Decreased cytokine activation and enhanced
post
surgical immune function may prove to be long-term benefits of VATS surgery.
Publication Types:
Review
Review, Tutorial
PMID: 8664015 [PubMed - indexed for MEDLINE]
284: Radiol Clin North Am. 1996 Jan;34(1):137-55.
Noncardiac thoracic surgical procedures. Definitions, indications, and
postoperative radiology.
Bhalla M.
Department of Radiology, Massachusetts General Hospital, Boston, USA.
The radiologist should be familiar with the various operative procedures of
the
chest to accurately interpret routine postoperative radiologic studies. This
also will assist them in the detection of common iatrogenic problems and
postoperative complications such as bleeding, air leak, and infection.
Furthermore, knowledge of serious and specific complications such as cardiac
herniation and post-pneumonectomy syndrome can help the radiologist play an
active role in the postoperative care of such patients.
Publication Types:
Review
Review, Tutorial
PMID: 8539348 [PubMed - indexed for MEDLINE]
285: Rev Inst Med Trop Sao Paulo. 1995 Nov-Dec;37(6):523-30.
Human pulmonary dirofilariasis: a review.
Rodrigues-Silva R, Moura H, Dreyer G, Rey L.
Departamento de Helmintologia, IOC/FIOCRUZ, Rio de Janeiro, Brasil.
The authors presented a detailed summary of the geographical distribution,
clinical and pathological aspects of human pulmonary dirofilariasis.
Although
benign, this zoonosis, of which Dirofilaria immitis is the major etiological
agent, represents a medical problem since it produces symptoms which may be
confused with neoplasia and thus may subject patients to unnecessary
thoracic
surgery. Of 229 cases cited in the literature, only 17 were reported in
Brazil,
despite the existence of highly favorable conditions for the transmission of
this infection in man. Thus it may well be that this parasitic infection
remains
underdiagnosed. Finally, the importance of a differential diagnosis between
dirofilariasis and pulmonary neoplasia is emphasized in cases where there is
a
solitary subpleural nodule ("coin lesion") present. In addition,
the development
and improvement of modern immunological diagnostic techniques are essential
to
distinguish this benign disease from other pathological conditions and thus
avoid unnecessary surgery. These techniques may reveal the true prevalence
of
this parasitic infection in our environment.
Publication Types:
Review
Review, Tutorial
PMID: 8731266 [PubMed - indexed for MEDLINE]
286: Ann Thorac Surg. 1995 Nov;60(5):1530-3.
Think before you prep: defining the terms of change in American healthcare.
Tanenbaum SJ.
Ohio State University College of Medicine, Columbus, USA.
United States physicians are grappling with a fundamental reorganization of
the
healthcare system. Although many remain skeptical of governmental efforts at
reform, they seem to take as given an industrial efficiency model of change,
including large and integrated managed care arrangements and performance
measurement based on outcomes such as quality. This uncharacteristic
acquiescence seems to derive in part from a confounding of concepts. This
article makes three distinctions: among knowledge about practice, knowledge
about quality, and outcomes research; between outcomes research and the
outcomes
movement; and between the outcomes movement and other options for healthcare
reform. The suggestion that statistical measurement of specific variables
ought
not to have a priori precedence over other ways of thinking--and doing
something--about healthcare is made.
Publication Types:
Review
Review, Tutorial
PMID: 8526681 [PubMed - indexed for MEDLINE]
287: Ann Thorac Surg. 1995 Nov;60(5):1526-9.
Quality initiatives and the power of the database: where we stand.
Kouchoukos NT.
Division of Cardiothoracic Surgery, Washington University School of
Medicine,
St. Louis, MO 63110, USA.
Many efforts to improve the quality of care focus on information drawn from
databases. Such information can be very useful; however, the acquisition and
analysis of data must be undertaken with caution. Six issues related to
quality
of care and the acquisition and analysis of data that pose problems for
thoracic
surgeons are the limitations and dangers of the right to know, the
inadequacy of
current databases, outcomes analysis and whether they help or hurt us,
increased
scrutiny of our practices, practice guidelines and the standards of care,
and
credentialing. To maximize the benefits of databases, physicians must
participate in the process of data acquisition and analysis and the
formation of
practice guidelines. Speaking out against the misuse of incomplete or
inaccurate
data and supporting Society initiatives that address these concerns will
help us
as we strive to maintain a strong physician-patient relationship and to
deliver
optimal care to our patients.
Publication Types:
Review
Review, Tutorial
PMID: 8526680 [PubMed - indexed for MEDLINE]
288: Ann Thorac Surg. 1995 Nov;60(5):1522-5.
Optimizing cardiothoracic surgery information for a managed care
environment.
Denton TA, Matloff JM.
Department of Cardiothoracic Surgery, Cedars-Sinai Medical Center, Los
Angeles,
CA 90048, USA.
The rapid change occurring in American healthcare is a direct response to
rising
costs. Managed care is the fastest growing model that attempts to control
escalating costs through limitations in patient choice, the active use of
guidelines, and placing providers at risk. Managed care is an information
intensive system, and those providers who use information effectively will
be at
an advantage in the competitive healthcare marketplace. There are five
classes
of information that providers must collect to be competitive in a managed
care
environment: patient satisfaction, medical outcomes, continuous quality
improvement, quality of the decision, and financial data. Each of these
should
be actively used in marketing, assuring the quality of patient care, and
maintaining financial stability. Although changes in our healthcare system
are
occurring rapidly, we need to respond to the marketplace to maintain our
viability, but as physicians, we have the singular obligation to maintain
the
supremacy of the individual patient and the physician-patient relationship.
Publication Types:
Review
Review, Tutorial
PMID: 8526679 [PubMed - indexed for MEDLINE]
289: Ann Thorac Surg. 1995 Nov;60(5):1514-21.
Quality initiatives and the power of the database: what they are and how
they
run.
Grover FL, Hammermeister KE, Shroyer AL.
Division of Cardiothoracic Surgery, University of Colorado Health Sciences
Center, Denver Veterans Affairs Medical Center, USA.
The criteria by which healthcare is judged or measured are quality,
accessibility, and cost effectiveness. To evaluate these criteria it is
important to have a database. There are many strengths and weakness to large
databases. They can be used as an indicator of the level of performance or
quality, for clinical decision making, and as a measurement of cost
effectiveness. They can also be useful in the evaluation and development of
treatment algorithms and critical pathways for patients with entry level
disease. In addition, they can measure patient access to healthcare and the
appropriateness of care. It is important for these databases to
appropriately
adjust for preoperative risk factors that may influence outcome. Outcome in
most
of the databases is measured by mortality, but morbidity, functional status,
quality of life, cost of care, length of stay, return to work, and patient
satisfaction are also important outcomes. Factors that can influence the
quality
of the outcome data are the methods by which the data are collected,
standardization of definitions, the currentness of the database, adequate
numbers of patients and outcomes, and appropriate analytic techniques. It is
important to feed back the data to the healthcare providers in a timely
enough
fashion so that processes and structures of care can be modified to improve
treatment and results. The reliability of the databases and the validity
must be
substantiated for the healthcare provider to have confidence in the
database.(ABSTRACT TRUNCATED AT 250 WORDS)
Publication Types:
Review
Review, Tutorial
PMID: 8526678 [PubMed - indexed for MEDLINE]
290: AJR Am J Roentgenol. 1995 Nov;165(5):1111-7.
Video-assisted thoracic surgery: the current state of the art.
Kaiser LR, Shrager JB.
Department of Surgery, University of Pennsylvania School of Medicine,
Philadelphia, USA.
Surgical thoracoscopy (or pleuroscopy) has historically been underused in
the
diagnosis and therapy of diseases of the chest. The rapid developments in
laparoscopy in recent years caused thoracic surgeons to reconsider the use
of
endoscopic techniques in surgery of the chest. Advances in video camera
technology and the use of digital processing technology so expanded the
potential of thoracoscopy that an entirely new set of procedures, called
video-assisted thoracic surgery, has emerged. This article reviews
situations in
which video-assisted procedures have proven useful, the techniques by which
these procedures are performed, and the rationale behind using the
video-assisted in lieu of the open approach. Video-assisted surgery often
allows
one to accomplish the same goal as the comparable open procedure but with
less
morbidity and a shorter hospital stay. With continued development of
instrumentation, increasingly complex procedures continue to be
accomplished. It
is important for radiologists to be aware of these new developments in
minimally
invasive surgery, as the techniques have major implications for the practice
of
chest medicine and surgery as a whole. The evolution of the management of
the
solitary pulmonary nodule is but one example of the way video-assisted
thoracic
surgery has called into question the traditional approach to diseases of the
chest.
Publication Types:
Review
Review Literature
PMID: 7572485 [PubMed - indexed for MEDLINE]
291: Chest. 1995 Sep;108(3):880-3.
Recurrent bronchogenic pseudocyst 24 years after incomplete excision. Report
of
a case.
Gharagozloo F, Dausmann MJ, McReynolds SD, Sanderson DR, Helmers RA.
Division of Cardiothoracic Surgery, Georgetown University School of
Medicine,
Washington, DC 20007, USA.
Bronchogenic cysts (BCs) are uncommon congenital anomalies. Due to the
inherent
complications, the mere presence of a BC should warrant surgical therapy.
Partial excision of these structures leads to recurrence. Complete surgical
excision using a thoracotomy or video-assisted thoracic surgery is the goal.
We
report a case of recurrent bronchogenic pseudocyst 24 years after initial
excision. This case supports the argument for complete surgical excision of
BCs
at the time of diagnosis.
Publication Types:
Case Reports
Review
Review of Reported
Cases
PMID: 7656652 [PubMed - indexed for MEDLINE]
292: J Cardiothorac Vasc Anesth. 1995 Aug;9(4):442-51.
Perioperative fluid management for thoracic surgery: the puzzle of
postpneumonectomy pulmonary edema.
Slinger PD.
Department of Anaesthesia, Montreal General Hospital, Quebec, Canada.
Publication Types:
Review
Review, Tutorial
PMID: 7579118 [PubMed - indexed for MEDLINE]
293: Clin Infect Dis. 1995 Jul;21(1):182-7.
Purulent pericarditis caused by Candida species: case report and review.
Schrank JH Jr, Dooley DP.
Department of Medicine, Dwight David Eisenhower Army Medical Center, Fort
Gordon, Georgia 30905, USA.
Purulent pericarditis caused by Candida species is a rare and often
undiagnosed
disease. We recently treated a patient in whom purulent pericarditis due to
Candida albicans developed following thoracic surgery. The patient survived
after receiving a combination of surgical and medical therapy. A literature
review revealed 24 additional cases of purulent pericarditis caused by
Candida
species. Twenty-one of the patients either had undergone thoracic surgery or
had
had disseminated candidiasis. None of the 12 patients described before 1980
survived, whereas six (46%) of the 13 patients described after 1980
survived. No
patient survived without pericardiectomy (five of six survivors) or at least
pericardiocentesis (one survivor). All survivors received full courses of
amphotericin B therapy. An increased utilization of echocardiography, along
with
an increased recognition of the patient populations at risk, has been
instrumental in early detection and improved outcome of purulent
pericarditis. A
combination of prolonged amphotericin B therapy and pericardiectomy appears
to
be the best approach for achieving a cure.
Publication Types:
Case Reports
Review
Review of Reported
Cases
PMID: 7578728 [PubMed - indexed for MEDLINE]
294: Chest Surg Clin N Am. 1995 May;5(2):289-96.
Extrapleural pneumonectomy for tuberculosis.
Brown J, Pomerantz M.
Department of Surgery, University of Colorado Health Sciences Center,
Denver,
USA.
Tuberculosis has infected the human race for thousands of years. The best
medical therapy in this country failed to eradicate the disease. In its
current
most virulent form it is drug resistant and will affect the practice of
thoracic
surgery once again. The most common indications for resection in patients
with
tuberculosis are drug resistance and localized disease. Pneumonectomy for
tuberculosis, now necessary in more than 50% of operative cases, represents
the
highest risk operation. The risk is related directly to patient
debilitation,
the preoperative presence of positive sputum, and intraoperative
contamination
of the pleural space. Complications can be minimized and an acceptable
mortality
rate can be achieved with an extrapleural approach supplemented by muscle
flap
or omentum for reinforcement of the bronchial stump.
Publication Types:
Review
Review, Tutorial
PMID: 7613965 [PubMed - indexed for MEDLINE]
295: Chest Surg Clin N Am. 1995 May;5(2):177-88.
Thoracic incisions.
Fry WA.
Northwestern University Medical School, Chicago, Illinois, USA.
There are many ways to gain access to the chest. In recent years, there has
been
a rediscovery of the clamshell incision, an evolving concept of the utility
incision for video-assisted thoracic surgery (VATS), and a continued
emphasis on
the importance and usefulness of the muscle-sparing axillary thoracotomy,
which
continues to be the author's most frequently used incision.
Publication Types:
Review
Review, Tutorial
PMID: 7613959 [PubMed - indexed for MEDLINE]
296: Semin Thorac Cardiovasc Surg. 1995 Apr;7(2):88-94.
Viral pulmonary infections in thoracic and cardiovascular surgery.
Avery RK, Longworth DL.
Department of Infectious Diseases, Cleveland Clinic Foundation, 1 Clinic
Center,
OH 44195, USA.
Viral respiratory infections are uncommon causes of pulmonary infiltrates in
immunocompetent patients who undergo cardiothoracic surgery. In winter
months,
however, influenza can be acquired in the community preoperatively or in the
hospital setting. The recognition of influenza cases is essential to prevent
nosocomial transmission. Respiratory syncytial virus is also an important
pulmonary pathogen in pediatric patients who undergo cardiothoracic surgery
and
may produce serious disease in children with underlying pulmonary or
congenital
heart disease. Viral infections of the respiratory tract are important
causes of
morbidity and mortality in heart and lung transplant recipients, especially
cytomegalovirus (CMV). Other herpes viruses such as varicella zoster virus
and
herpes simplex virus may also occasionally involve the lung. Epstein-Barr
virus
has been incriminated in the pathogenesis of post-transplant
lymphoproliferative
disease, an uncommon but severe complication of transplantation. Except for
Epstein-Barr virus, effective therapy exists for CMV and the other herpes
viruses. Prophylaxis with ganciclovir is effective in preventing serious CMV
infections in seropositive heart transplant recipients. However, better
strategies are needed to prevent primary CMV infection in these patients.
Publication Types:
Review
Review, Tutorial
PMID: 7612760 [PubMed - indexed for MEDLINE]
297: Clin Chest Med. 1995 Mar;16(1):29-44.
Epidemiology of nosocomial pneumonia in intensive care unit patients.
George DL.
Baptist Memorial Hospital, Memphis, Tennessee, USA.
Pneumonia is the most commonly reported nosocomial infection in ICU
patients,
occurring predominantly in patients whose lungs are ventilated, at a rate of
1%
to 3% per day of mechanical ventilation. Substantially increased costs and
mortality have been attributed to nosocomial pneumonia. Our understanding of
the
epidemiology of nosocomial pneumonia in ICU populations has been limited by
the
reliance of most published studies on clinical diagnostic criteria, which
are
nonspecific. In addition to mechanical ventilation and tracheal intubation,
other suspected risk factors of importance include chronic lung disease,
age,
severity of illness, upper abdominal or thoracic surgery, head trauma or
depressed level of consciousness, and gastric acid inhibition. Aspiration
appears to be the primary mode of inoculation of microorganisms into the
distal
lung; however, the relative importance of different sites as reservoirs for
aspiration is controversial. It is hoped that studies based on improved
diagnostic techniques, such as quantitative cultures of protected brush or
bronchoalveolar lavage specimens, will provide the basis for an improved
understanding of the epidemiology and prevention of this important infection
in
critically ill patients.
Publication Types:
Review
Review, Tutorial
PMID: 7768093 [PubMed - indexed for MEDLINE]
298: W V Med J. 1995 Mar-Apr;91(3):95-7.
Left atrial myxoma: a case presentation and review of the literature.
Law DA, Dulaney JJ, Graeber G.
Department of Medicine, West Virginia University School of Medicine,
Morgantown,
USA.
Cardiac myxomas account for 24% of all primary cardiac tumors. The majority
occur in the left atrium and are attached via a pedunculated stalk. The
presentation may mimic primary myocardial dysfunction or obstructive
valvular
disease. Frequently, the diagnosis is delayed secondary to only vague
constitutional symptoms. In this article, we present a case of a left atrial
myxoma discovered after thoracic surgery in a patient with elevated
pulmonary
pressures thought to be secondary to mitral stenosis, and demonstrate how
transesophageal echocardiography is useful in the evaluation of critically
ill
patients with cardiac tumors.
Publication Types:
Case Reports
Review
Review of Reported
Cases
PMID: 7747493 [PubMed - indexed for MEDLINE]
299: Eur J Obstet Gynecol Reprod Biol. 1995 Feb;58(2):167-71.
The omentoplasty: a neglected ally in gynecologic surgery.
Logmans A, Trimbos JB, van Lent M.
Department of Gynecology, Daniel den Hoed Clinic, Rotterdam, The
Netherlands.
Although the omentum is extensively used in general, reconstructive and
thoracic
surgery as a pedicled omentoplasty, little information exists about the
utility
of such a procedure in general and radical gynecologic surgery. In this
paper we
review the properties of the omentum which may be useful in gynecologic
surgery.
The omentum is highly vasculated and rich in thromboplastin, an excellent
property for treating difficult to handle abdominal or pelvic abscesses and
for
inducing hemostasis. Furthermore, it appears that the omentum has a
trophical
effect on the surrounding tissue, making it very useful in reconstruction
procedures. Moreover, elevating the small intestines out of the true pelvis
paves the way for high dose (brachy)radiotherapy with less radiation
enteritis.
The technique of the pedicled omentoplasty is straightforward and takes
20-30
min extra operating time. We use pedicled omentoplasty for covering large
operating fields instead of reperitonealization, to prevent radiation
enteritis,
as a matrix for grafting, to treat serious intraperitoneal infections and to
facilitate hemostasis. Our experience of 48 omentoplasty procedures in
gynecology is described.
Publication Types:
Review
Review, Tutorial
PMID: 7774745 [PubMed - indexed for MEDLINE]
300: Acta Cardiol. 1995;50(5):381-6.
The complications of thoracic surgery: prophylaxis and treatment of
arrhythmias.
Van Mieghem W.
Department of Cardiology, Limburgs Hartcentrum, Genk, Belgium.
Publication Types:
Review
Review, Tutorial
PMID: 8967283 [PubMed - indexed for MEDLINE]
301: Clin Plast Surg. 1995 Jan;22(1):187-98.
Chest wall reconstruction.
Mathes SJ.
Department of Surgery, University of California, School of Medicine, San
Francisco, USA.
Chest wall defects are frequently encountered in all regions of the chest.
Initial defect assessment includes evaluation of location, extent, and
etiology
of the defect. Reconstructive options include flap transposition, tissue
expansion, and microvascular composite tissue transplantation. Partial
thickness
defects are readily covered with skin grafts if viable muscle is present in
the
wound base. Complex defects, particularly related to wound debridement for
osteomyelitis or osteoradionecrosis, are covered with regional muscle or
musculocutaneous flaps. Extensive full-thickness defects frequently require
restoration of the bony defect. Split rib grafts are preferred for elective
sterile extirpative defects. Complex defects with unfavorable wound
environment
(chronic open wound or osteoradionecrosis) may require use of Prolene mesh
to
maintain chest wall stability and to provide support for the overlying flap.
Tissue expansion is useful for partial thickness defects in order to provide
optimal contour and skin quality at the site of reconstruction and to avoid
additional scars at distant donor sites (see Fig. 6). Microsurgical
composite
tissue transplantation will allow complex defect closure when regional
muscle or
musculocutaneous flaps are unavailable. With careful defect analysis in
regard
to reconstructive requirements, the surgeon may select appropriate options
from
the reconstructive triangle to accomplish safe chest wall reconstruction
with
optimal form and function.
Publication Types:
Review
Review, Tutorial
PMID: 7743705 [PubMed - indexed for MEDLINE]
302: Cancer Invest. 1995;13(5):526-39.
Comment in:
Cancer Invest.
1995;13(5):551-2.
The role of video-assisted thoracic surgery in thoracic oncological
practice.
Landreneau RJ, Mack MJ, Hazelrigg SR, Naunheim KS, Keenan RJ, Ferson PF.
Section of Thoracic Surgery, University of Pittsburgh, Pennsylvania, USA.
Publication Types:
Review
Review, Tutorial
PMID: 7552821 [PubMed - indexed for MEDLINE]
303: Ann Surg. 1994 Dec;220(6):720-34.
Video-assisted thoracic surgery. Current state of the art.
Kaiser LR.
Department of General Thoracic Surgery, University of Pennsylvania, School
of
Medicine, Philadelphia.
OBJECTIVE. The author reviews the current state of the art of video-assisted
thoracic surgery in the context of modern thoracic surgical practice.
SUMMARY
BACKGROUND DATA. Thoracoscopy has been a part of thoracic surgical practice
for
many years, but was used mainly for diagnosis of pleural disease. The
development of laparoscopic cholecystectomy awakened a new interest in this
technique and led to the development of many new therapeutic and diagnostic
applications of video-assisted thoracic surgery. METHODS. Current literature
and
the author's personal experience with more than 500 cases are reviewed.
RESULTS.
Video-assisted techniques have proven useful for the performance of a broad
spectrum of thoracic surgical procedures. Patients may experience less pain
and
have a shorter hospital stay after a video-assisted procedure. Definitive proof
of less morbidity when compared with the analagous open procedure remains to
be
determined. Patient acceptance has been high, and most thoracic surgeons use
these techniques in their practice. CONCLUSIONS. Video-assisted thoracic
surgical procedures have made a significant impact on the practice of
thoracic
surgery. Advantages and disadvantages of specific procedures remain to be
definitively determined. Surgeons have learned these techniques and have
kept
morbidity to acceptance levels during the learning phase. Where these
techniques
ultimately fit into the overall practice remains to be determined as more
experience is gained.
Publication Types:
Review
Review, Academic
PMID: 7986137 [PubMed - indexed for MEDLINE]
304: Ann Med. 1994 Dec;26(6):401-4.
The role of videothoracoscopy in the diagnosis and treatment of chest
diseases.
Salo JA.
Department of Thoracic and Cardiovascular Surgery, Helsinki University
Central
Hospital, Finland.
Recent developments in video camera techniques, new instruments and advanced
surgical techniques have increased the importance of thoracoscopy in both
the
diagnosis and therapy of diseases of the chest. Many diseases previously
demanding open thoracotomy (i.e. spontaneous pneumothorax, biopsies of lung,
pleura and mediastinum, several benign intrathoracic tumours, achalasia and
reflux disease of the esophagus) can, today, be treated by video-assisted
thoracic surgery with the same results as by using open procedures. The
advantages of this technique compared to open thoracotomy include less
operative
trauma, less postoperative pain, good cosmetic results and shorter hospital
stay. The drawbacks are the more difficult technique, demanding special
education, the possibility of inadequate radicality in the treatment of
malignant diseases and the necessity of longer operating time. The physician
performing thoracoscopic surgery must also master the techniques of open
procedures.
Publication Types:
Review
Review, Tutorial
PMID: 7695864 [PubMed - indexed for MEDLINE]
305: Chest. 1994 Nov;106(5):1617-9.
Video-assisted thoracic surgery for delayed pericardial effusion post-CABG.
Hurley JP, Subarreddy K, McCarthy J, Wood AE.
Department of Cardiothoracic Surgery, Mater Hospital, Dublin, Ireland.
Delayed-onset pericardial effusion following coronary artery bypass grafts
can
give rise to significant morbidity in its presentation and in its management
by
traditional surgical techniques. A video-assisted thoracoscopic technique to
create a pericardial window, with the advantage of a minimally invasive
approach
combined with excellent visualization in such a patient is described.
Publication Types:
Case Reports
Review
Review of Reported
Cases
PMID: 7956436 [PubMed - indexed for MEDLINE]
306: Semin Surg Oncol. 1994 Nov-Dec;10(6):411-6.
Minimally invasive surgery for pulmonary and esophageal tumors.
McKenna RJ Jr.
Department of Surgery, University of Southern California School of Medicine,
Los
Angeles 90017.
The development of endoscopic video capabilities has opened a new era in
thoracic operations. This paper discusses video-assisted thoracic surgery
(VATS)
as part of the armamentarium of the thoracic surgeon. VATS is the procedure
of
choice for a solitary pulmonary nodule. It is also a useful staging
procedure in
selected patients with pulmonary and esophageal tumors. The role of VATS in
the
definitive resection of certain lung cancers is discussed and there is a
call
for randomized controlled studies to determine if there is an advantage for
the
utilization of VATS. The use of VATS for resection of esophageal tumors is
discussed. It is currently under development and investigation.
Publication Types:
Review
Review, Tutorial
PMID: 7855477 [PubMed - indexed for MEDLINE]
307: Aust N Z J Surg. 1994 Oct;64(10):667-70.
Video-assisted thoracoscopic surgery for primary spontaneous pneumothorax.
Yim AP, Ho JK, Chung SS, Ng DC.
Department of Surgery, Chinese University of Hong Kong, Prince of Wales
Hospital, Shatin.
Video-assisted thoracoscopic surgery (VATS) has been suggested as the most
appropriate choice for spontaneous pneumothorax. Thirty-two patients (30
males,
two females, age range from 16 to 42) with primary spontaneous pneumothorax
(PSP) are reported. All had mechanical pleurodesis with Marlex mesh. Blebs
or
bullae could be identified in 24 patients (75%). All bullae over 2 cm were
either excised (11 patients) or ligated (five patients). The median
operating
time was 45 min. There was minimal postoperative discomfort and the median
postoperative hospital stay was 4 days. There was one minor wound infection
and
one recurrence (mean follow up of 11 months). It is concluded that VATS is a
quick, safe and effective approach for the treatment of PSP. Long-term
results
will better define its true merit in thoracic surgery.
Publication Types:
Clinical Trial
Review
Review, Multicase
PMID: 7945061 [PubMed - indexed for MEDLINE]
308: Environ Health Perspect. 1994 Oct;102 Suppl 5:221-4.
Epidemiological significance of mineral fiber persistence in human lung
tissue.
McDonald JC.
Epidemiological Research Unit, Royal Brompton National Heart and Lung
Institute,
London, UK.
For the experimentalist, mineral fiber persistence may provide clues to
disease
mechanisms, for the epidemiologist, to the measurement of exposure.
Qualitatively, this can be valuable when unsuspected exposures have been
demonstrated as, for example, MMMF workers exposed to amosite or chrysotile
workers to tremolite. Quantitatively, the potential of lung burden analyses
to
assess lifetime mineral fiber exposure has yet to be achieved with
confidence.
The difficulties are 2-fold, the first related to sampling and the second to
the
dynamics of biopersistence. Until some noninvasive method is found to
identify
and quantify numerically inorganic fibers in human tissue during life,
epidemiological studies must depend on lung samples obtained at autopsy or
thoracic surgery. This source is inevitably subject to seriously large and
indefinable bias of various kinds. Of equal importance is the present
uncertain
state of knowledge concerning factors that determine what is present in the
lung
at any time. These determinants clearly include the dimensional features of
airborne environmental particulates and characteristics that affect their
durability in tissue.
Publication Types:
Review
Review, Tutorial
PMID: 7882937 [PubMed - indexed for MEDLINE]
309: Anesthesiology. 1994 Sep;81(3):737-59.
Pain control after thoracic surgery. A review of current techniques.
Kavanagh BP, Katz J, Sandler AN.
Department of Anaesthesia, Stanford University Medical Center, California
94305-5117.
Publication Types:
Review
Review, Tutorial
PMID: 8092520 [PubMed - indexed for MEDLINE]
310: Radiol Clin North Am. 1994 Jul;32(4):663-78.
Radiologic assessment after lung transplantation.
Herman SJ.
University of Toronto, Ontario, Canada.
Imaging studies play a major role in patients undergoing lung
transplantation.
These patients are subject to unusual problems, such as the reimplantation
response, acute rejection, bronchiolitis obliterans, ischemia-induced airway
complications, and immuno-suppression-associated lymphoma. In addition,
these
patients are also subject to all of the usual problems associated with
thoracic
surgery, including atelectasis, infection, pneumothorax, and pleural
effusion,
all conditions for which radiologic assessment is crucial.
Publication Types:
Review
Review, Tutorial
PMID: 8022973 [PubMed - indexed for MEDLINE]
311: Am J Hosp Pharm. 1994 Jun 15;51(12):1539-54.
Effect of analgesic treatment on the physiological consequences of acute
pain.
Lewis KS, Whipple JK, Michael KA, Quebbeman EJ.
College of Pharmacy, Xavier University of Louisiana, New Orleans 70125.
Physiological responses to acute pain are described, and the effects of
different analgesic techniques on these responses are discussed. The body's
response to acute pain can cause adverse physiological effects. Pain can
impede
the return of normal pulmonary function, modify certain aspects of the
stress
response to injury, and alter hemodynamic values and cardiovascular
function. It
can produce immobility and contribute to thromboembolic complications. In
addition, pain can slow a patient's recovery from surgery and contribute to
increased morbidity. Fewer pulmonary complications occur when adequate
analgesia
is provided through the use of epidural narcotics and local anesthetics,
particularly if the injury or surgery involves the lower part of the body.
Continuous morphine infusions, intercostal nerve blocks, and transcutaneous
electrical stimulation do not alter the frequency of pulmonary
complications.
The effectiveness of patient-controlled analgesia in reducing postoperative
pulmonary complications is still not known. Epidural local anesthetic
therapy
inhibits the stress response, particularly in operations involving the lower
abdomen or extremities; this technique is less effective during major
abdominal
procedures. Suppression of endocrine-metabolic changes following lower
abdominal
surgery requires neural block to the fourth thoracic segment. Epidural
narcotics
partially inhibit the stress response after lower abdominal or extremity
surgery
but not after upper abdominal or thoracic surgery. Local anesthetics applied
to
the surgical site, intercostal nerve blocks, and intrapleural and
intraperitoneal administration also do not modify the stress response.
Adequate
analgesia through the use of local anesthetics and narcotics postoperatively
generally results in improved cardiovascular function, decreased pulmonary
morbidity and mortality, earlier ambulation, and decreased likelihood of
deep
vein thrombosis. Some data suggest that improved patient outcome occurs with
adequate analgesia. Block of afferent and efferent neural pathways by local
anesthetics seems to be the most effective analgesic modality in lessening
the
physiologic response to pain and injury.
Publication Types:
Review
Review, Tutorial
PMID: 8092155 [PubMed - indexed for MEDLINE]
312: Surg Annu. 1994;26:251-68.
The use of greater omentum in reconstructive surgery.
Marschall MA, Cohen M.
University of Illinois at Chicago, College of Medicine.
Publication Types:
Review
Review, Tutorial
PMID: 8303522 [PubMed - indexed for MEDLINE]
313: Clin Intensive Care. 1994;5(3):123-9.
The paediatric chest tube.
Brandt ML, Luks FI, Lacroix J, Guay J, Collin PP, Dilorenzo M.
Department of Surgery, Baylor College of Medicine, Houston, TX 77030-2399,
USA.
Chest tubes are placed to empty the pleural space of air or fluid which
prohibits full lung expansion. The function of these tubes is dependent on
adequate placement, effective drainage and frequent re-evaluation of the
patient
and the chest drainage system. Knowledge of the principles of chest tube
drainage is important to evaluate adequately the function of a tube
thoracostomy.
Publication Types:
Review
Review, Tutorial
PMID: 10150541 [PubMed - indexed for MEDLINE]
314: Blood Coagul Fibrinolysis. 1993 Dec;4(6):1007-21.
Thrombogenic mechanisms in the human: fresh insights obtained by
immunodiagnostic studies of coagulation markers.
Boisclair MD, Philippou H, Lane DA.
Department of Haematology, Charing Cross and Westminster Medical School,
Hammersmith, London, UK.
Although in vitro studies have been invaluable in revealing the complex
biochemistry of the blood coagulation system, meaningful in vivo studies of
thrombogenic mechanisms have previously been hindered by the absence of
suitable
assays. This article reviews the recent development and/or contemporary
clinical
application of plasma-based immunoassays for coagulation markers (factor
XIIa,
factor IX activation peptide, prothrombin fragment F1 + 2,
thrombin-antithrombin
complex and fibrinopeptide A) and for the fibrinolytic marker, D-dimer,
which
have enabled a critical re-appraisal of some long-standing hypotheses. In
chronic renal disease the intrinsic coagulation pathway was found to be
activated before haemodialysis and increased end-stage coagulation activity
was
detected during dialysis when heparinization was limiting. No evidence was
found
to support the generally accepted hypothesis that thrombogenesis in dialysis
is
triggered by stimulation of the contact system following exposure of blood
to
the dialyser membrane. Instead, it is postulated that it is a failure of
regulation of end-stage coagulation proteinases (owing to the absence of
endothelium) which is responsible for increased thrombogenesis in the
dialyser
circuit. Excessive end-stage coagulation activity was observed during
cardiopulmonary bypass (CPB) surgery and in patients undergoing general
thoracic
surgery. The data did not accord with the hypothesis that the contact system
provides the major thrombogenic trigger in CPB surgery. It is proposed that,
in
general thoracic surgery, a powerful procoagulant stimulus is provided via
the
tissue factor-factor VIIa pathway and that the same mechanism is also
primarily
responsible for triggering thrombogenesis during CPB surgery. The
established
hypothesis of a prethrombotic state in hereditary AT III deficiency is
challenged by the inability to detect increased coagulation activity in
asymptomatic AT III deficient patients. It is concluded that the AT III
concentration in deficient members is sufficient to enable regulation of the
coagulation system in the basal state, whereas failure to regulate the
coagulation system only occurs following a major procoagulant stimulus,
which
overwhelms the impaired inhibitory capacity and triggers thrombosis. These
findings highlight the advantages of using plasma-based immunoassays to
investigate thrombogenic mechanisms in hypercoagulable states and have
important
implications for the further study and treatment of blood-surface
interactions
and thrombotic disease.
Publication Types:
Review
Review, Tutorial
PMID: 8148474 [PubMed - indexed for MEDLINE]
315: South Med J. 1993 Nov;86(11):1286-91.
Internal closure of an aspergilloma cavity: report of a new technique and
review
of the literature.
Bolton JW, Lazar HL.
Department of Cardiothoracic Surgery, Boston University Medical Center,
Mass.
We have described a case in which closure of an aspergilloma cavity was done
internally when it was determined that pulmonary resection was too
hazardous.
There was an intense inflammatory reaction surrounding the aorta and
pulmonary
artery. In the absence of gross purulence and underlying parenchymal
infection,
this technique may be used to avoid the prolonged hospitalization and
bronchopleural fistulas associated with external drainage procedures.
Publication Types:
Case Reports
Review
Review of Reported
Cases
PMID: 8235789 [PubMed - indexed for MEDLINE]
316: Eur Respir J. 1993 Nov;6(10):1544-55.
Thoracoscopy: present diagnostic and therapeutic indications.
Loddenkemper R, Boutin C.
Chest Hospital Heckeshom, Berlin, Germany.
Thoracoscopy is increasingly being used for diagnosis and treatment of
pleuropulmonary disease. The recent revival was made possible by the
tremendous
advances in endoscopic technology. The main requirements for diagnostic
purposes
are rigid telescopes and forceps, and for interventional thoracoscopy
scissors,
staplers and a video recorder. The procedure can be performed either under
local
or general anaesthesia, with or without double lumen intubation, after
inducing
an artificial pneumothorax. At the end of the procedure, a chest tube should
always be inserted, even if only for a few minutes until the lung
re-expands.
Main diagnostic indications are pleural effusions, pneumothorax and diffuse
lung
disease. Main therapeutic indications are pleurodesis by talcage in effusion
and
pneumothorax and a variety of diseases of the lung, the pleura and the
mediastinum, where thoracotomy may be replaced by video-assisted
thoracoscopy.
The well-known indications of the past remain a domain of pneumologists,
whereas
minimal invasive thoracotomy is the task of thoracic surgeons. For some
indications no sharp line has to be drawn, provided the facilities and
skills
are present, including those for the management of complications.
Publication Types:
Review
Review, Tutorial
PMID: 8112449 [PubMed - indexed for MEDLINE]
317: Semin Thorac Cardiovasc Surg. 1993 Oct;5(4):280-3.
Set-up and present indications: video-assisted thoracic surgery.
Miller DL, Allen MS.
Section of General Thoracic Surgery, Mayo Clinic, Rochester, MN 55905.
Publication Types:
Review
Review, Tutorial
PMID: 8268263 [PubMed - indexed for MEDLINE]
318: Endosc Surg Allied Technol. 1993 Oct-Dec;1(5-6):249-52.
Thoracic surgery: the irreversible evolution toward endoscopic surgery.
Gossot D.
Department of Surgery, Hopital Saint-Louis, Paris, France.
Endoscopic techniques have established themselves as an important means for
reducing the traumatic impact of thoracic surgery on the patient. They
considerably lighten postoperative pain and are cosmetically much more
pleasing.
Procedures such as lung biopsy, pericardial window, treatment of spontaneous
pneumothorax, mediastinal benign tumour excision and sympathectomy have
become
routine, other such as oesophagectomy require further evaluation. Advanced
procedures such as lobectomy and pneumonectomy require further clinical and
technological development prior to a conclusive assessment.
Publication Types:
Review
Review, Tutorial
PMID: 8081891 [PubMed - indexed for MEDLINE]
319: Ann Thorac Surg. 1993 Sep;56(3):762-8.
The role of video-assisted thoracic surgery for carcinoma of the lung: wedge
resection to lobectomy by simultaneous individual stapling.
Lewis RJ.
University of Medicine and Dentistry of New Jersey, Robert Wood Johnson
Medical
School, New Brunswick.
Despite a plethora of technologic advances, there has been only minimal
improvement in the surgical treatment of carcinoma of the lung during the
past
15 years. The advent of video-assisted thoracic surgical (VATS) techniques,
however, is opening up new vistas and providing unimagined options for more
accurate diagnosis, more precise staging, and more specific resections of
lung
tumors. Currently, a voluminous surgical literature supports tissue
conservation, in selected patients, for the curative resection of peripheral
malignant nodules less than 2 cm in diameter. Because these lesions are very
accessible to a VATS resection, such procedures can be satisfactorily
performed
to meet the individual needs of the patient (ie, wedge, subsegmental,
segmental,
and sublobar resections, as well as traditional or SIS-lobectomy
[simultaneous
individual stapling of hilar structures]). As the technology advances,
members
of other specialties are beginning to develop a keen interest in the
treatment
of carcinoma of the lung. If thoracic surgeons are to prevail in the
treatment
of carcinoma of the lung, for the benefit of their patients, they must
remain
vigilant, informed, and versatile in their approach to this disease. This
involves learning, understanding, and incorporating these new technologic
advances into their armamentarium.
Publication Types:
Review
Review, Tutorial
PMID: 8379790 [PubMed - indexed for MEDLINE]
320: Ann Thorac Surg. 1993 Sep;56(3):721-30.
Thoracoscopic surgery: the Belgian experience.
Coosemans W, Lerut TE, Van Raemdonck DE.
Division of Thoracic Surgery, U.Z. Gasthuisberg, Leuven, Belgium.
Despite the already wide experience with video-assisted techniques in
laparoscopic surgery, video-assisted thoracic surgery only recently came to
be
developed. This is clearly seen in a survey reflecting the experience among
Belgian surgeons. A majority of the surgeons (63%) had limited experience (1
to
5 interventions), and only 28.5% had fairly considerable (between 11 and 20
interventions) or considerable (more than 20 interventions) experience. The
majority of interventions performed were the treatment of pneumothorax, lung
biopsies, wedge resections, and intrathoracic staging procedures, accounting
for
209 (70%) of the 296 interventions collected in this survey. The remaining
interventions display a wide variety of different thoracic procedures
including
lobectomy (4) and esophagectomy (20) for carcinoma. The overall technical
success rate was 91% in this survey. Our own experience with 71
interventions or
attempts reflects the same evolution with an overall technical success rate
in
85% (60 patients). Pneumothorax was the most frequently performed
intervention
(35 patients), with a technical success rate of 94.5% (32 patients).
Recurrences
requiring further treatment occurred in 5 of the 32 patients (14.3%). All
recurrences occurred before endostaplers were available, after which there
were
no failures in 12 consecutive cases. Other procedures successfully performed
were lung biopsy/wedge resection (6), lung cancer staging procedures (3),
lobectomy (1), hemothorax (3), chest wall neurinoma (2), sympathectomy (5),
dorsal mediastinal neurinoma (1), thymectomy (1), esophagectomy (3), benign
esophageal tumor enucleation (2), and Belsey Mark IV antireflux procedure
(1).
Furthermore, special emphasis was given to the development of video-assisted
mediastinoscopy, which greatly facilitates teaching and interpreting this
operation. Endoscopic myotomy using endostaplers was performed in 2 patients
with Zenker's diverticulum. From our experience, however, it becomes clear
that
thoracoscopic approaches do not always result in a distinct benefit for the
patient, as these procedures are more time consuming and usually require
one-lung ventilation (probably the cause of the only fatal outcome in this
series: a lung biopsy in an 85-year-old patient). In conclusion,
video-assisted
thoracic and thoracoscopic surgery is a new surgical modality offering new
perspectives. However, careful patient selection and the same expertise as
in
open procedures are essential in determining the final outcome of each
procedure.
Publication Types:
Multicenter Study
Review
Review, Multicase
PMID: 8379780 [PubMed - indexed for MEDLINE]
321: Ann Thorac Surg. 1993 Sep;56(3):704-7.
Pediatric thoracoscopy: where have we come and what have we learned?
Rodgers BM.
Division of Pediatric Surgery, Children's Medical Center, University of
Virginia
Health Sciences Center, Charlottesville 22908.
The procedure of thoracoscopy was employed in adult patients for more than
half
a century before the first report evaluating its use in children was published
in 1976. Initially thoracoscopy was proposed as a technique for obtaining
pulmonary biopsy specimens in immunocompromised children when interstitial
pneumonia developed, but, as more experience with the technique was gained,
new
indications for its use in children have arisen. A review of the published
reports on the use of thoracoscopy in children has brought to light areas in
which the procedure has been particularly useful as well as several
limitations
of the procedure. In properly selected patients, thoracoscopy is an
extremely
accurate method of tissue diagnosis for diffuse and localized pulmonary
infiltrates. This technique may be the procedure of choice in the diagnosis
of
mediastinal lesions in children and in the surgical treatment of empyema and
pneumothorax. Most of the morbidity and mortality reported for the procedure
have been in patients with diffuse interstitial pneumonias. Such patients,
who
are on high-pressure ventilator support, are best managed by a standard open
lung biopsy. Maintenance of a sufficient pneumothorax has proved difficult
in
very small infants and children, and the procedure may not be applicable in
children who weigh under 8 kg. Refinements in thoracoscopy instrumentation
will
allow the performance of more complicated surgical dissections as pediatric
surgeons acquire more familiarity with this technique.
Publication Types:
Review
Review, Tutorial
PMID: 8379776 [PubMed - indexed for MEDLINE]
322: Ann Thorac Surg. 1993 Sep;56(3):649-50.
The role of thoracoscopy in the AIDS/immunocompromised patient.
Feins RH.
Division of Cardiothoracic Surgery, University of Rochester, New York 14642.
A review of the thoracic complications associated with the immunosuppression
seen in the setting of the acquired immunodeficiency syndrome (AIDS),
transplantation, and cancer chemotherapy was undertaken to define the role
of
thoracoscopy and video-assisted thoracic surgery in this context. Pulmonary
parenchymal disease, pleural effusions, pneumothorax, and pericardial
effusions
are the primary conditions in which thoracoscopy can be helpful.
Thoracoscopic
wedge biopsy can be used in patients with parenchymal disease when
bronchoalveolar lavage, transbronchial biopsy, or an empiric trial of
antibiotics fail to yield a diagnosis. If pleural effusions are loculated
and
highly fibrinous, effective drainage can be achieved thoracoscopically.
Early
bleb stapling and apical pleurectomy are often necessary in the management
of
AIDS-related pneumothorax and can be readily done using video-assisted
thoracic
surgical techniques. Successful thoracoscopy in the immunocompromised
patient
requires the ability to tolerate one-lung anesthesia, a manageable lung
parenchyma, and a satisfactory coagulation profile.
Publication Types:
Review
Review, Tutorial
PMID: 8379762 [PubMed - indexed for MEDLINE]
323: Ann Thorac Surg. 1993 Sep;56(3):630-2.
Pain management principles and anesthesia techniques for thoracoscopy.
Mulder DS.
Department of Surgery, Montreal General Hospital/McGill University, Quebec,
Canada.
Thoracic surgeons have recently pursued innovative techniques that can help
minimize postoperative pain. These have taken two basic directions. The
first
consists of a modification of the operative procedure itself, such that the
surgical insult and hence the resulting pain are minimized. Modifications of
the
conventional thoracotomy technique have led to the development of the
muscle-sparing thoracotomy and the linear or small transaxillary
thoracotomy.
The ultimate modification has been video-assisted thoracic surgery
techniques,
which are associated with a marked reduction in postoperative pain. The
second
approach centers on techniques that improve postoperative pain control. The
recently published Agency Health Care Policy and Research guidelines provide
a
comprehensive review of the therapeutic options for postoperative pain control.
These guidelines emphasize the value of nonsteroidal antiinflammatory drugs
in
conjunction with opioids as the preferred form of analgesia. Many authors
have
advocated the induction of spinal analgesia after thoracotomy, using either
epidural opioids or local anesthesia, or both. Patient-controlled analgesia
and
multiple intercostal nerve blocks are other methods for managing
postthoracotomy
pain. The potential benefits conferred by aggressive pain control after
thoracotomy are enormous for the patients, the surgeons, and the entire
health-care system.
Publication Types:
Review
Review, Tutorial
PMID: 8379756 [PubMed - indexed for MEDLINE]
324: Ann Thorac Surg. 1993 Sep;56(3):624-9.
Anesthetic techniques for thoracoscopy.
Horswell JL.
Medical City Dallas, Dallas, Texas.
With the advent of laparoscopic techniques for application in the chest, as
well
as the development of new video equipment and instrumentation technology,
the
cardiothoracic surgeon can now perform procedures that, until very recently,
were performed only by thoracotomy. Modern thoracoscopy has not reached its
final resolution, but a growing number of procedures have been performed
that
permit some initial recommendations to be made and that define areas of
research
for the anesthesiologist. A review of the physiology of the lateral
decubitus
position will act as a basis for developing rational decisions concerning
the
conduction of anesthesia for thoracoscopy. Future research and experience in
thoracoscopy will help to further define appropriate anesthetic techniques.
Publication Types:
Review
Review, Tutorial
PMID: 8379755 [PubMed - indexed for MEDLINE]
325: Ann Thorac Surg. 1993 Sep;56(3):615-9.
Strategic planning for video-assisted thoracic surgery.
Landreneau RJ, Mack MJ, Keenan RJ, Hazelrigg SR, Dowling RD, Ferson PF.
Section of Thoracic Surgery, University of Pittsburgh, PA 15213.
As with any operative procedure, careful preoperative and intraoperative
planning are vital to achieving a safe and effective video-assisted thoracic
surgical intervention. We outline some of our basic strategies for enhancing
the
success of this approach in the management of thoracic surgical problems.
Publication Types:
Review
Review, Tutorial
PMID: 8379753 [PubMed - indexed for MEDLINE]
326: Curr Probl Surg. 1993 Sep;30(9):817-912.
Vascular disorders of the upper torso.
Humphrey PW, Spadone DP, Silver D.
University of Missouri-Columbia.
Publication Types:
Review
Review, Tutorial
PMID: 8354079 [PubMed - indexed for MEDLINE]
327: Surg Clin North Am. 1993 Aug;73(4):633-44.
The surgical anatomy and technique of the thoracoabdominal incision.
Lumsden AB, Colborn GL, Sreeram S, Skandalakis LJ.
Emory University School of Medicine, Atlanta, Georgia.
The thoracoabdominal incision provides excellent exposure of the thoracic,
abdominal, and retroperitoneal compartments and can be safely performed in
the
vast majority of cases. To be more specific, the advantage of the left
thoracoabdominal incision is excellent exposure of the lower esophagus, the
gastroesophageal junction, the gastric cardia and stomach in toto, the left
hemidiaphragm, the distal pancreas and spleen, the left kidney and adrenal
gland, and the aorta. The advantage of the right thoracoabdominal incision
is
excellent exposure of the upper esophagus, the liver, the hepatic triad and
inferior vena cava, the proximal pancreas, the right hemidiaphragm, the
right
kidney, and the adrenal gland. Several possible disadvantages should also be
taken into consideration when contemplating this procedure. Morbidity and
mortality may be increased with the opening of the two cavities. The surgeon
must possess good detailed anatomic technique for opening and closure. This
procedure is not advisable for children; it should be used only for good
technical indications. Some of the more commonly encountered anatomic
complications to be avoided include (1) splenic injury, occurring most often
during division and resection of the diaphragm; (2) phrenic nerve injury,
with
subsequent diaphragmatic dysfunction; (3) ureteric injury during
retroperitoneal
dissection; (4) left first lumbar vein injury (located in the posterior
aspect
of the left renal vein) during left kidney mobilization; and (5) pain in the
early postoperative period, which can occur secondary to transection of the
cartilaginous costal arch. This may be minimized by secure fixation using
No. 1
Prolene. Patients occasionally complain of a clicking sensation owing to
nonunion of the costal cartilage.
Publication Types:
Review
Review, Tutorial
PMID: 8378814 [PubMed - indexed for MEDLINE]
328: Br J Hosp Med. 1993 Jul 14-Aug 17;50(2-3):114-20.
Management of pain in thoracic surgery.
Sabanathan S, Richardson J, Mearns AJ.
Bradford Royal Infirmary.
Severe pain after thoracotomy is the most important factor responsible for
ineffective ventilation, ineffective cough, and impaired ability to sigh and
to
breathe deeply. Effective analgesia minimizes and may even reverse the
expected
decline in pulmonary function and also prevents postoperative pulmonary
complications.
Publication Types:
Review
Review, Tutorial
PMID: 8353663 [PubMed - indexed for MEDLINE]
329: Transfus Med Rev. 1993 Jul;7(3):173-9.
Fibrin glue in cardiothoracic surgery.
McCarthy PM.
Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic
Foundation,
OH 44195.
Publication Types:
Review
Review, Tutorial
PMID: 8347983 [PubMed - indexed for MEDLINE]
330: Clin Plast Surg. 1993 Jul;20(3):559-71.
Radiation-related wounds of the chest wall.
Granick MS, Larson DL, Solomon MP.
Department of Plastic and Reconstructive Surgery, Medical College of
Wisconsin,
Milwaukee.
Irradiation-associated chest wall lesions pose a significant health hazard
to
the patient. The principles of management include (1) biopsy of any open
wounds
to rule out the recurrence or persistence of tumor, (2) aggressive
debridement
of all offending tissues, and (3) reconstruction with well-vascularized flap
tissue. Numerous questions arise regarding the practical management of these
patients. The controversies that have arisen during our management of more
than
100 of these patients have been discussed. It is appropriate to perform
reconstruction following nonhealing of a superficial ulcer or immediately
following the excision of a full-thickness chest wall defect. Hyperbaric
oxygen
can serve as a useful adjunct. It is rarely necessary to use a prosthetic
material for the purpose of chest wall stabilization during the
reconstruction
of full-thickness defects. Paradoxic chest wall movement in the
postoperative
period does not significantly affect pulmonary function tests and is
generally a
transient problem. Subtotal excisions are frequently necessary. As long as
all
of the necrotic or tumor-bearing tissue has been fully removed, these wounds
can
be expected to heal in most instances by placing vascularized tissue into
the
defect. Operative sites in previously irradiated chest wall tissue can be
expected to heal if proper and careful surgical technique is employed.
Nevertheless, there is a risk of wound breakdown following any surgery in
irradiated tissue. Finally, we believe it is appropriate to proceed with
aesthetic recontouring of chest wall deformities associated with irradiation
exposure.
Publication Types:
Case Reports
Review
Review, Tutorial
PMID: 8324994 [PubMed - indexed for MEDLINE]
331: Clin Chest Med. 1993 Jun;14(2):293-303.
Physiology of lung resection.
Bolton JW, Weiman DS.
Department of Cardiothoracic Surgery, University of Texas Health Science
Center,
San Antonio.
Although we speak intuitively about the effects of lung resection, little
thought is given to the precise physiologic mechanisms. The effects of
different
thoracic incisions on the chest wall mechanics, the removal of pulmonary
parenchyma on lung function, and the interaction of the cardiopulmonary
apparatus all combine to result in specific physiologic derangements after
thoracic surgery.
Publication Types:
Review
Review, Tutorial
PMID: 8519174 [PubMed - indexed for MEDLINE]
332: Ann Thorac Surg. 1993 Apr;55(4):822-9.
Comment in:
Ann Thorac Surg.
1994 Jan;57(1):263-4.
The role of the gut in the development of multiple organ dysfunction in
cardiothoracic patients.
Baue AE.
Department of Surgery, St. Louis University School of Medicine, Missouri
63110-0250.
Interest in the importance of the gut after injury or operation has waxed
and
waned over this century. Recent studies implicate the gut in septic
complications and multiple organ failure after trauma, operations including
cardiothoracic procedures, starvation, and other serious illnesses. Changes
in
the gut in sick patients include stress ulceration, bacterial overgrowth
from
stress ulceration prophylaxis, mucosal atrophy, loss of barrier function,
increased permeability, and bacterial translocation. Such changes in
relation to
multiorgan failure are reviewed, along with methods to support the gut and
prevent gastrointestinal failure. Preventive measures include stress
ulceration
prophylaxis, selective gut decontamination, enteral feeding, and adjuvants
to
promote gut function such as glutamine, fiber, and growth hormone. In
cardiothoracic operations, the gut may be altered by the "whole
body"
inflammatory processes of cardiopulmonary bypass. Gastrointestinal
complications
after cardiothoracic operations are related primarily to low flow states. In
5,924 patients having cardiothoracic operations at St. Louis University
Hospital
from 1985 to 1991, multiorgan failure developed in 128 patients, with a
mortality of 78%. Significant gastrointestinal problems occurred and
contributed
to multiorgan failure in a number of these patients. Support of the
gastrointestinal tract and the prevention of multiorgan failure are
important
for the cardiothoracic surgeon.
Publication Types:
Review
Review, Tutorial
PMID: 8123067 [PubMed - indexed for MEDLINE]
333: Med Clin North Am. 1993 Mar;77(2):309-25.
What is the value of preoperative pulmonary function testing?
Celli BR.
Pulmonary Section, Department of Veterans Affairs, Boston, Massachusetts.
This article reviews the current information regarding the value of
different
tests of lung function in patients undergoing abdominal or thoracic surgery.
Risk factors as well as the pathophysiology of postoperative pulmonary
complications are also discussed. Finally, a rational approach synthesizing
clinical features with pulmonary function test results to estimate risk and
minimize complication is presented.
Publication Types:
Case Reports
Review
Review, Tutorial
PMID: 8441297 [PubMed - indexed for MEDLINE]
334: Surg Annu. 1993;25 Pt 1:49-81.
The principles and applications of surgical adhesives.
Papatheofanis FJ, Barmada R.
Department of Orthopaedics, University of Illinois College of Medicine,
Chicago.
Publication Types:
Review
Review, Tutorial
PMID: 8416147 [PubMed - indexed for MEDLINE]
335: Surg Annu. 1993;25 Pt 2:117-49.
Noncardiac thoracic surgery in children: an overview.
Karrer FM, Hall RJ, Lilly JR.
Publication Types:
Review
Review, Tutorial
PMID: 8351585 [PubMed - indexed for MEDLINE]
336: Ann Radiol (Paris). 1993;36(2):145-60.
Surgery for congenital malformations of the lung.
Vogt-Moykopf I, Rau B, Branscheid D.
Thoraxklinik, Heidelberg-Rohr-Bach, Germany.
In the course of a survey conducted in 59 hospitals performing thoracic surgery,
14 hospitals supplied data that could be used for the study. Out of 1347
anomalies diagnosed 1343 were surgically treated, with a 30-day mortality
rate
of 0.3% (5 patients). In a retrospective study over a period of 10 years
(1978-1988) we identified 198 anomalies out of a total of 6350
thoracotomies; so
our percentage grading of pulmonary anomalies is supported by the data of
the
above-mentioned survey according to which cystic pulmonary malformations
such as
inhibition malformations, excess malformation and lobar emphysema represent
a
majority with 72.2% (survey 83%). Congenital anomalies of lung formation
occurred in 23% of the patients of the survey and in 15% of our own
patients.
Therapy consisted of parenchyma-saving surgery, i.e. enucleation (n = 87),
segmental resection (n = 65) and lobectomy (n = 63) with bronchoplastic
reconstruction; there was no 30-day mortality. Adenomatoid-cystic
malformation,
lymphangiectasis, congenital lobar emphysema and stenosis of the
tracheobronchial tree are often an indication for immediate surgical
treatment
in neonates. Solitary cysts, bronchiectasis, sequestration of the lung, an
AV-fistula present with symptoms mostly between the ages of 20-40 and
therefore
were surgically treated secondarily.
Publication Types:
Review
Review Literature
PMID: 8333716 [PubMed - indexed for MEDLINE]
337: Scanning Microsc. 1992 Dec;6(4):1041-58; discussion 1058-60.
Information and misinformation regarding ischemia of heart muscle tissue.
The
cause of cell death during blood reperfusion and reactivation of heart
muscle
tissue after prolonged ischemia.
Sjostrand FS.
Department of Biology, University of California, Los Angeles 90024-1606.
An electron microscopic study of heart muscle tissue exposed to six hours
ischemia and prepared according to the low denaturation embedding technique
revealed a structural modification confined to the mitochondrial cristae.
The
modification consisted of a removal of Krebs cycle enzymes from the cristae.
Reperfusion of the ischemic tissue after four hours ischemia led to
extensive
breakdown of the mitochondrial structure and contractility could not be
restored. However, when after six hours ischemia the ischemic tissue was
reperfused with blood, the composition of which had been modified to
stimulate
mitochondrial function, no additional structural changes were observed and
contractility was restored. The structural damage caused by reperfusion with
non
modified blood is explained by a loss of control of plasma membrane
permeability
caused by impaired ATP production which makes the ionic composition of the
cytosol approach that of blood plasma, stopping oxidative phosphorylation. A
treatment to restore heart muscle function after long periods of ischemia
and
after heart transplantation is proposed. The structural damage revealed that
the
Krebs cycle and the respiratory chain enzymes are associated according to a
regular periodic pattern and that the enzyme molecules are closely
aggregated
three-dimensionally. Earlier electron microscopic studies revealing massive
structural deterioration of heart muscle cells already after 45 to 60
minutes
ischemia leading to the conclusion that the cells are irreversibly damaged,
is
based on fixation artifacts caused by osmium fixation. This study has been
carried out in collaboration with the research team of Gerald D. Buckberg at
the
Thoracic Surgery Division at University of California at Los Angeles.
Publication Types:
Review
Review, Tutorial
PMID: 1295075 [PubMed - indexed for MEDLINE]
338: Thorac Cardiovasc Surg. 1992 Dec;40(6):326-9.
Perioperative antibiotic prophylaxis in general thoracic surgery.
Wertzel H, Swoboda L, Joos-Wurtemberger A, Frank U, Hasse J.
Department of Pulmonary Surgery, University Hospital, Freiburg, Germany.
A prospective study of the efficacy of ampicillin in combination with
sulbactam,
a beta-lactamase inhibitor, (A/S) in perioperative prophylaxis was
performed.
The study consisted of two independent parts performed at the same time.
Part I
included 60 patients with lobectomies and segmentectomies. Group A (A/S 1 x
3 g
"single shot") was compared with group B (A/S 3 x 3 g). Superficial
wound
infections occurred in 3 patients of group A and in 2 patients of group B.
There
was no empyema. Bronchitis and pneumonia were found in 10 patients of group
A
and in 7 patients of group B. Part II examined 25 pneumonectomies receiving
A/S
3 x 3 g for 3 days. Concentrations of ampicillin and sulbactam in serum and
lung
tissue were determined and showed adequate levels to cope with usual
bacteria in
lung surgery. There was one superficial wound infection, 2 cases of
bronchitis,
and 2 cases of pneumonia.
Publication Types:
Clinical Trial
Randomized
Controlled Trial
Review
Review Literature
PMID: 1290178 [PubMed - indexed for MEDLINE]
339: Med J Aust. 1992 Sep 7;157(5):340-3.
Human albumin solutions: consensus statements for use in selected clinical
situations. Subcommittee of the Victorian Drug Usage Advisory Committee.
[No authors listed]
OBJECTIVE: To establish consensus statements for the use of human albumin
solutions in clinical situations identified as responsible for the major use
of
human albumin products. DESIGN AND SETTING: Working parties comprised of
specialists in intensive care, renal medicine, cardiothoracic anaesthesia,
gastroenterology, haematology and transfusion medicine, were convened to
develop
consensus statements for the use of human albumin solutions. RESULTS:
Specific
statements have been formulated to guide the clinician in the use of human
albumin solutions for hypovolaemia or hypoalbuminaemia (particularly in
intensive care units), cardiothoracic surgery, therapeutic plasma exchange
and
patients with ascites or protein-losing states in gastroenterology.
CONCLUSIONS:
These statements, with wide dissemination, will promote consistency in the
use
of human albumin products in clinical practice and become a reference for
future
audits on the use of these products.
Publication Types:
Consensus
Development Conference
Review
PMID: 1435481 [PubMed - indexed for MEDLINE]
340: Br J Nurs. 1992 Sep 24-Oct 7;1(10):492-5.
Minitracheostomy: the benefits for patient care.
Nelson S.
Sputum retention is a potential complication following thoracic surgery.
This
article describes minitracheostomy, a technique that is commonly used in
thoracic units to clear secretions, examines its advantages and
disadvantages
and recommends its more widespread use in district general hospitals.
Publication Types:
Review
Review, Tutorial
PMID: 1421986 [PubMed - indexed for MEDLINE]
341: Ann Thorac Surg. 1992 Aug;54(2):286-8.
Pulmonary torsion: a questionnaire survey and a survey of the literature.
Wong PS, Goldstraw P.
Royal Brompton National Heart and Lung Hospital, London, England.
Pulmonary torsion is a rare but life-threatening complication of thoracic
operations and trauma. A questionnaire was sent to 140 thoracic surgeons in
the
United Kingdom to examine its incidence, particularly torsion of the middle
lobe
after right upper lobectomy. The answers from 117 thoracic surgeons (84%)
were
collected and analyzed. Thirty-five responders (30%) had seen one or more
cases
of pulmonary torsion. The majority of cases occurred after pulmonary
resection,
and most of these instances involved middle lobe torsion after right upper
lobectomy. In total, 39 cases were reported; 1 (3%) occurred spontaneously
in an
azygos lobe, 2 (5%) were seen after trauma, 28 (72%) were seen after
pulmonary
resections and 8 (21%), after other procedures. In this group of responders,
27
(77%) routinely fix the middle lobe to the remaining lobe after right upper
or
lower lobectomy, upper lobe fixation being required only if the transverse
fissure is well developed. Of the 82 responders who had never seen instances
of
pulmonary torsion, only 47 (57%) routinely do this fixation.
Publication Types:
Review
Review of Reported
Cases
PMID: 1637221 [PubMed - indexed for MEDLINE]
342: Br J Surg. 1992 Aug;79(8):745-9.
Chest physiotherapy for the surgical patient.
Stiller KR, Munday RM.
Physiotherapy Department, Royal Adelaide Hospital, Australia.
This article reviews the evidence that chest physiotherapy is effective in
the
prevention and treatment of pulmonary complications after major abdominal
and
thoracic surgery. There is some evidence that regular chest physiotherapy
significantly decreases the incidence of pulmonary complications, although
the
mechanism of this effect is uncertain. It is not known whether chest
physiotherapy is effective in the treatment of postoperative pulmonary
complications after they have developed.
Publication Types:
Review
Review, Tutorial
PMID: 1393458 [PubMed - indexed for MEDLINE]
343: Clin Pharm. 1992 May;11(5):391-414.
Acute pain management: operative or medical procedures and trauma, Part 2.
Agency for Health Care Policy and Research.
[No authors listed]
Summary recommendations 1-5 and 7 should be implemented in every hospital
where
operations are performed on inpatients. The Acute Pain Management Guideline
Panel recommends that any hospital in which abdominal or thoracic operations
are
routinely performed offer patients postoperative regional anesthetic,
epidural
or intrathecal opioids, PCA infusions, and other interventions requiring a
similar level of expertise, under the supervision of an acute pain service
as
described in summary recommendation 6. For pain management to be effective,
each
hospital must designate who or which department will be responsible for all
of
the required activities. There are a number of alternative approaches to
preventing or relieving postoperative pain, many of which can give good
results
if attentively applied. The following elements, however, apply to most cases
and
might serve as a focus for assessing the results of these guidelines: 1.
Promise
patients attentive analgesic care. Patients should be informed before
surgery,
orally and in printed format, that effective pain relief is an important
part of
their treatment, that talking about unrelieved pain is essential, and that
health professionals will respond quickly to their reports of pain. It
should be
made clear to patients and families, however, that the total absence of any
postoperative discomfort is normally not a realistic or even a desirable
goal.
2. Chart and display assessment of pain and relief. A simple assessment of
pain
intensity and pain relief should be recorded on the bedside vital sign chart
or
a similar record that encourages easy, regular review by members of the
health
care team and is incorporated in the patient's permanent record. The
intensity
of pain should be assessed and documented at regular intervals (depending on
the
severity of pain) and with each new report of pain. The degree of pain
relief
should be determined after each pain management intervention, once a
sufficient
time has elapsed for the treatment to reach peak effect. A simple, valid
measure
of intensity and relief should be selected by each clinical unit. For
children,
age-appropriate measures should be used. 3. Define pain and relief levels to
trigger a review. Each institution should identify pain intensity and pain
relief levels that will elicit a review of the current pain therapy,
documentation of the proposed modifications in treatment, and subsequent
review
of its efficacy. This process of treatment review and follow-up should
include
participation by physicians and nurses involved in the patient's
care.(ABSTRACT
TRUNCATED AT 400 WORDS)
Publication Types:
Guideline
Practice Guideline
Review
Review, Academic
PMID: 1582131 [PubMed - indexed for MEDLINE]
344: Heart Lung. 1992 Mar;21(2):125-38.
The effects of epidural versus parenteral opioid analgesia on postoperative
pain
and pulmonary function in adults who have undergone thoracic and abdominal
surgery: a critique of research.
Simpson T, Wahl G, DeTraglia M, Speck E, Taylor D.
Rochester General Hospital, N.Y.
Studies comparing epidural and parenteral opioid analgesia for patients
experiencing thoracic or abdominal surgery are analyzed with respect to
differences in postoperative pain and pulmonary function. Although most
studies
suggest that epidural analgesia is superior for postoperative pain relief,
few
clearly demonstrate an improvement in pulmonary function attributable to
epidural analgesia. Recommendations for future research are proposed to
improve
the design, measurement, analysis, and reporting of studies. Research
relevant
to the nursing care of patients receiving epidural analgesia is suggested.
Publication Types:
Review
Review, Multicase
PMID: 1544806 [PubMed - indexed for MEDLINE]
345: Ann Chir. 1992;46(2):141-56.
Surgery for congenital malformations of the lung.
Vogt-Moykopf I, Rau B, Branscheid D.
Thoraxklinik, Heidelberg-Rohrbach, Germany.
In the course of a survey conducted in 59 hospitals performing thoracic
surgery,
14 hospitals supplied data that could be used for the study. Out of 1347
anomalies diagnosed 1343 were surgically treated, with a 30-day mortality
rate
of 0.3% (5 patients). In a retrospective study over a period of 10 years
(1978-1988) we identified 198 anomalies out of a total of 6350
thoracotomies; so
our percentage grading of pulmonary anomalies is supported by the data of
the
above-mentioned survey according to which cystic pulmonary malformations
such as
inhibition malformations, excess malformation and lobar emphysema represent
a
majority with 72.2% (survey 83%). Congenital anomalies of lung formation
occurred in 23% of the patients of the survey and in 15% of our own
patients.
Therapy consisted of parenchyma-saving surgery, i.e. enucleation (n = 87),
segmental resection (n = 65) and lobectomy (n = 63) with bronchoplastic
reconstruction; there was no 30-day mortality. Adenomatoid-cystic
malformation,
lymphangiectasis, congenital lobar emphysema and stenosis of the
tracheobronchial tree are often an indication for immediate surgical
treatment
in neonates. Solitary cysts, bronchiectasis, sequestration of the lung, an
AV-fistula present with symptoms mostly between the ages of 20-40 and
therefore
were surgically treated secondarily.
Publication Types:
Review
Review Literature
PMID: 1605537 [PubMed - indexed for MEDLINE]
346: Pharmacotherapy. 1992;12(2):132-43.
Patient-controlled analgesia: a review.
Smythe M.
Department of Pharmacy Practice, Wayne State University, Detroit, MI 48202.
The patient-activated analgesic system was introduced in 1968. Early trials,
although uncontrolled, supported the safety and efficacy of
patient-controlled
analgesia (PCA) in several kinds of pain, such as that relating to surgery,
cancer, trauma, and obstetric procedures. In the past decade, prospective,
randomized trials have reported several advantages of PCA over conventional
analgesia in the early postoperative period. Although not supported by all
controlled trials, they include improved pain relief, less sedation, lower
level
of narcotic consumption, fewer postoperative complications, greater patient
satisfaction, and improved pulmonary function. Preliminary results in the
management of chronic pain indicate that PCA can lead to significant
lifestyle
improvements in ambulatory patients with cancer. The most significant,
although
infrequent, adverse effect is respiratory depression, the majority of cases
occurring in patients predisposed secondary to concomitant illness or as a
result of human error. The clinical use of PCA will likely see a significant
increase among persons with cancer, and an increase in epidural
administration.
The cost benefit of PCA has yet to be assessed in inpatient and outpatient
settings.
Publication Types:
Review
Review, Tutorial
PMID: 1570228 [PubMed - indexed for MEDLINE]
347: Clin Plast Surg. 1991 Oct;18(4):823-8.
Male chest correction. Pectoral implants and gynecomastia.
Aiache AE.
Implants have been developed in different sizes and shapes to mimic the
pectoralis major muscle and its nipple-areolar complex below it. These soft,
solid silicone implants have the approximate dimensions in height, length,
and
thickness as the muscle the implant is to mimic. Some improvements in the
treatment of breast hypertrophy have also allowed a better result in the
surgery
of gynecomastia. The challenge of obtaining a smooth and flat result has
been
helped by the technique of liposuction with circum-areolar excision.
Publication Types:
Review
Review, Tutorial
PMID: 1934895 [PubMed - indexed for MEDLINE]
348: Clin Plast Surg. 1991 Oct;18(4):797-813.
Male body contouring.
Mladick RA.
Plastic Surgery Center, Inc., Virginia Beach, Virginia.
Male body contouring is discussed in regard to indications and patient
selection. General guidelines are given for anesthesia, positioning,
preoperative marking, and operating room preparation. The technique is
discussed
for facial, chest, and abdominal contouring. Suction lipoplasty,
abdominoplasty,
flankplasty, and thigh contouring are discussed in detail.
Publication Types:
Review
Review, Tutorial
PMID: 1934893 [PubMed - indexed for MEDLINE]
349: Clin Chest Med. 1991 Sep;12(3):497-506.
Double-lumen endotracheal tubes.
Strange C.
Medical Intensive Care Unit, Medical University of South Carolina,
Charleston.
Double-lumen endotracheal tubes have revolutionized the anesthetic
management of
patients undergoing thoracic surgery. As experience with the techniques of
DLT
placement and monitoring progress, an increasing number of uses in the
intensive
care unit will evolve. Benefit from differential lung ventilation in
patients
with respiratory failure from unilateral lung diseases and bronchopleural
fistulae has been documented in selected instances. Isolation of the lungs
to
prevent contralateral spread of hemoptysis is occasionally of assistance.
Frequent monitoring of DLT position while understanding the physiology of
differential lung ventilation will minimize complications with these tubes.
Publication Types:
Review
Review, Tutorial
PMID: 1934951 [PubMed - indexed for MEDLINE]
350: Rev Infect Dis. 1991 Sep-Oct;13 Suppl 10:S869-73.
Antibiotic prophylaxis in clean surgery: peripheral vascular surgery,
noncardiovascular thoracic surgery, herniorrhaphy, and mastectomy.
Hopkins CC.
Department of Medicine, Massachusetts General Hospital, Boston 02114.
Studies published in the English-language literature on the use of
prophylactic
systemic antibiotics in vascular surgery, noncardiovascular thoracic
surgery,
mastectomy, and herniorrhaphy were reviewed. The effectiveness of antibiotic
prophylaxis in preventing deep and superficial wound infections in
peripheral
vascular surgery appears to be well documented, especially if prophylaxis is
directed against Staphylococcus aureus. In clean thoracic surgery the
evidence
is equivocal, and no studies have sufficient statistical power to eliminate
the
possibility even of a 50% reduction in incidence. In herniorrhaphy and
mastectomy some evidence from a much more powerful study suggests that
antibiotic prophylaxis may result in a decrease of up to 50% in wound
infections, but whether these data can be generalized uncritically to all
clean
wounds is still a matter of debate. Accordingly, only guarded
recommendations
can be made regarding the use of prophylactic antibiotics in procedures
associated with a very low risk of serious infection.
Publication Types:
Clinical Trial
Review
Review, Tutorial
PMID: 1754796 [PubMed - indexed for MEDLINE]
351: Clin Orthop. 1991 Sep;(270):79-86.
Local control and survival from the Cooperative Osteosarcoma Study Group
studies
of the German Society of Pediatric Oncology and the Vienna Bone Tumor
Registry.
Winkler K, Bieling P, Bielack S, Delling G, Dose C, Jurgens H, Kotz R,
Ritter J,
Salzer-Kuntschik M.
Department of Pediatric Hematology and Oncology, University of Hamburg,
Germany.
The use of aggressive chemotherapy undoubtedly has brought about a dramatic
increase in the cure rate of osteosarcoma. The authors' investigations have
increased the authors' knowledge of chemotherapy for osteosarcoma, the
differential efficacy of currently used agents, and the pronounced schedule
dependency and relative route independency of their efficiency. The authors
were
able to confirm the prognostic significance of tumor response after
preoperative
chemotherapy. Preoperative chemotherapy in itself has facilitated and
promoted
limb-salvage surgery. Also, more patients can be cured today by use of
aggressive thoracic surgery in case of primary or secondary pulmonary
metastases. The authors' efforts to steadily increase metastasis-free
survival
rates by intensifying chemotherapy in this series of studies, however, have
been
only moderately successful. Still, chemotherapy-related acute toxicity is
considerable and increases with aggressiveness of treatment, and the
manifestations of late toxicity may continue to increase with follow-up
time.
Future trials should be targeted toward exploration of the minimum
indispensable
amount of toxic treatment yielding comparable or even better results than
those
currently attainable.
Publication Types:
Clinical Trial
Multicenter Study
Review
Review, Tutorial
PMID: 1715820 [PubMed - indexed for MEDLINE]
352: Med J Aust. 1991 Jul 1;155(1):29, 32-3.
Comment in:
Med J Aust. 1991
Oct 7;155(7):500.
Male sexuality. 1. Medical causes of male sexual dysfunction.
Richardson JD.
Publication Types:
Review
Review, Tutorial
PMID: 2067430 [PubMed - indexed for MEDLINE]
353: J Thorac Imaging. 1991 Jul;6(3):80-8.
Surgical management of thoracic empyema.
Wallenhaupt SL.
Department of Cardiothoracic Surgery, Bowman Gray School of Medicine, Wake
Forest University, Winston-Salem, NC 27103.
Thoracic empyema usually results from pulmonary infection or thoracic
surgery.
Antibiotic therapy is an essential part of the treatment, but surgical
techniques to drain the pleural fluid and obliterate the empyema space often
are
required. A wide range of closed and open surgical techniques are available.
This article reviews the various surgical options for the treatment of
nontuberculous bacterial empyema secondary to pulmonary infection in the
patient
with a normal immune response. Emphasis is placed on a thorough
understanding of
the pathophysiology and natural history of empyema for selection and timing
of
appropriate treatment. Thoracic imaging techniques play a substantial role
in
the evaluation and treatment of empyema and in assessing the outcome of
surgical
therapy.
Publication Types:
Review
Review, Tutorial
PMID: 1861278 [PubMed - indexed for MEDLINE]
354: Semin Respir Infect. 1991 Jun;6(2):94-102.
Antibiotic therapy of pleural empyema.
Hughes CE, Van Scoy RE.
Division of Infectious Diseases and Internal Medicine, Mayo Clinic,
Rochester,
MN 55905.
Most empyemas occur as a complication of pneumonia or lung abscess, but 15%
to
30% occur after thoracic surgery and 10% occur in association with an
intraabdominal infection. The bacteriology of empyemas that occur in
association
with lung infections is often polymicrobial and mixed, containing multiple
species of both aerobic and anaerobic bacteria, the latter found in up to
75% of
cases. In contrast, empyema following thoracic surgery is more likely to be
monomicrobial and caused by common nosocomial pathogens such as
Staphylococcus
aureus and aerobic gram-negative bacilli. Diffusion of antibiotics into both
infected and uninfected pleural fluid is good, but certain agents
(aminoglycosides and some beta-lactams) may be inactivated in the presence
of
pus, low pH, and beta-lactamase enzymes. Single antibiotic agents that are
likely to be active against the wide spectrum of potential pathogens include
imipenem-cilastatin and ticarcillin-clavulanic acid. Combinations of
antibiotics
should include an effective agent against anaerobic bacteria (clindamycin,
metronidazole) coupled with an agent active against aerobic gram-positive
cocci
and gram-negative bacilli.
Publication Types:
Review
Review, Tutorial
PMID: 1771308 [PubMed - indexed for MEDLINE]
355: Can J Anaesth. 1991 Apr;38(3):384-400.
Comment in:
Can J Anaesth.
1991 Oct;38(7):938-9.
Perioperative functional residual capacity.
Wahba RW.
Department of Anaesthesia, Queen Elizabeth Hospital, Montreal, Quebec,
Canada.
The literature dealing with the magnitude, mechanism and effects of reduced
FRC
in the perioperative period is reviewed. During general anaesthesia FRC is
reduced by approximately 20%. The reduction is greater in the obese and in
patients with COPD. The most likely mechanism is the loss of inspiratory
muscle
tone of the muscles acting on the rib cage. Gas trapping is an additional
mechanism. Lung compliance decreases and airways resistance increases, in
large
part, due to decreased FRC. The larynx is displaced anteriorly and
elongated,
making laryngoscopy and intubation more difficult. The change in FRC creates
or
increases intrapulmonary shunt and areas of low ventilation to perfusion.
This
is due to the occurrence of compression atelectasis, and to regional changes
in
mechanics and airway closure which tend to reduce ventilation to dependent
lung
zones which are still well perfused. Abdominal and thoracic operations tend
to
increase shunting further. Large tidal volume but not PEEP will improve
oxygenation, although both increase FRC. Both FRC and vital capacity are
reduced
following abdominal and thoracic surgery in a predictable pattern. The
mechanism
is the combined effect of incisional pain and reflex dysfunction of the
diaphragm. Additional effects of thoracic surgery include pleural effusion,
cooling of the phrenic nerve and mediastinal widening. Postoperative
hypoxaemia
is a function of reduced FRC and airway closure. There is no real difference
among the various methods of active lung expansion in terms of the speed of
restoration of lung function, or in preventing postoperative
atelectasis/pneumonia. Epidural analgesia does not influence the rate of
recovery of lung function, nor does it prevent atelectasis/pneumonia.
Publication Types:
Review
Review, Tutorial
PMID: 2036700 [PubMed - indexed for MEDLINE]
356: DICP. 1991 Mar;25(3):239-43.
Use of albumin in a university hospital: the value of targeted physician
intervention.
Stumpf JL, Lechner JL, Ryan ML.
University of Michigan Hospitals and College of Pharmacy, Ann Arbor.
Results of a preliminary study of albumin use at the University of Michigan
Hospital were shared with one surgical service (thoracic surgery) that had a
documented high rate of inappropriate use. To determine the effectiveness of
this targeted educational intervention in reducing inappropriate use and
associated drug costs, albumin prescribing for all adult inpatients at
University Hospital over a 30-day period was assessed in a retrospective
review.
Eighty-six patients used a total of 843 units, a ten percent reduction in
total
albumin use. Albumin administration to thoracic surgery patients decreased
by 38
percent. The 35 percent reduction in inappropriate albumin use by this
service
(Fisher's exact test, p less than 0.001) was associated with an estimated
annual
cost savings of +83,500. Inappropriate albumin use by other medical services
generally increased over previously measured levels. This study demonstrated
the
effectiveness of targeted educational interventions in reducing
inappropriate
albumin use and thereby controlling rising healthcare costs.
Publication Types:
Review
Review, Tutorial
PMID: 2028628 [PubMed - indexed for MEDLINE]
357: Prog Pediatr Surg. 1991;27:30-52.
Nursing perspectives in the management of infants and children requiring
thoracic surgery.
Telfer H, Willis S.
Department of Nursing, Royal Children's Hospital Melbourne, Parkville,
Victoria,
Australia.
Nurses who care for infants and children undergoing thoracic surgery must
function and make decisions which take into account a multiplicity of
complex
data. This necessitates a background of knowledge, skill and intuition which
guides their nursing practice. The principles of holistic care in which the
total needs of the infant and child are met within the context of the family
are
seen as an important approach to patient care. Selected perspectives in the
care
of infants with congenital and acquired thoracic anomalies are discussed, in
particular infants with congenital diaphragmatic hernia and oesophageal
atresia.
The preparation of children for chest surgery and the postoperative nursing
management are outlined and include aspects of pain management,
physiotherapy
and chest drain care.
Publication Types:
Review
Review, Tutorial
PMID: 1907387 [PubMed - indexed for MEDLINE]
358: Prog Pediatr Surg. 1991;27:170-90.
An approach to the management of chest wall deformities.
Myers NA.
Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.
Chest wall deformities are seen frequently in children and adolescents.
Fortunately, the deformity is usually mild and the only therapeutic
requirement
is patient and family reassurance. If the deformity is more severe,
consideration must be given to surgical correction. Although sophisticated
studies have shown that cardiopulmonary function may be limited by funnel
chest,
the findings are rarely of clinical significance and, therefore, with few
exceptions, operations will be performed for cosmetic and/or psychological
reasons. In order to be able to manage patients with chest wall deformities
appropriately, clarity of thinking is essential in relation to
classification,
symptomatology and treatment options. Before reaching a final decision
regarding
operation, several interviews may be required. In order to assess the final
result, long-term follow-up is mandatory.
Publication Types:
Review
Review, Tutorial
PMID: 1907382 [PubMed - indexed for MEDLINE]
359: Neurosurg Clin N Am. 1991 Jan;2(1):187-226.
Thoracic outlet syndrome. Thoracic surgery perspective.
Luoma A, Nelems B.
Department of Surgery, University of British Columbia, Canada.
We have attempted throughout this review to identify the issues surrounding
thoracic outlet syndrome as well as to highlight their origins. It should be
clear that many aspects of TOS remain controversial from the definition of
the
entity through pathogenesis, diagnosis, and treatment. The conflicts
surrounding
TOS are underlined most poignantly in the many letters to the editor of the
New
England Journal of Medicine in response to Urschel's 1972 publication. It is
incumbent upon those of us who treat patients with TOS to dispel the
ignorance
surrounding this syndrome with astute, accurate, and reproducible
observations.
We must clearly define TOS as a clinical entity such that we may analyze the
characteristics of the patients we treat. We must continue to search for
innovative and specific diagnostic criteria. We must quantitatively and
reproducibly measure subjective end points of pain severity and quality of
life.
The use of these methods will provide yardsticks for therapeutic success and
act
as determinants for the natural history of TOS. The objectives of treatment
will
remain the alleviation of symptoms and the restoration of function. We have
applied these principles to the formulation of a protocol in which we
record, in
a prospective manner, both routine and innovative clinical parameters. With
quantification of subjective end points, we may be able to correlate
clinical
presentation with outcome. We also may be able to define with some accuracy
this
entity we call thoracic outlet syndrome.
Publication Types:
Review
Review, Tutorial
PMID: 1821732 [PubMed - indexed for MEDLINE]
360: Cardiol Clin. 1990 Nov;8(4):639-44.
Acute pericarditis.
Shabetai R.
University of California, San Diego.
Acute pericarditis may be of viral or idiopathic origin, may be induced by
certain drugs, may occur as a consequence of thoracic surgery, may result
from
infection by bacteria or other organisms, or may be associated with
noninfectious systemic disease. In some instances, pericarditis may be
detected
quickly, and in other cases it may not be recognized until late. This
article
discusses clinical findings, clinical course, and treatment of acute
pericarditis. In addition, diagnosis and treatment of pericardial effusion
are
presented.
Publication Types:
Review
Review, Tutorial
PMID: 2249218 [PubMed - indexed for MEDLINE]
361: Jpn J Surg. 1990 Nov;20(6):620-6.
New uses of the laser in thoracic and cardiovascular surgery.
Michaelis LL, LoCicero J 3rd, Hartz RS, McCarthy WJ.
Department of Surgery, Northwestern University Medical School, Chicago,
Illinois
60611.
Lasers have been accepted in general thoracic surgery as resectional tools
which
allow precise hemostasis and maximal salvage of normal lung tissue. Used
endoscopically, with or without associated photodynamic therapy, we have
provided acceptable palliation in some patients with obstructing tumors of
the
tracheobronchial tree and esophagus. Cardiovascular uses of the laser have
been
under extensive investigation at our medical center for many years. We have
demonstrated that laser-assisted anastomosis of small vessels is possible,
that
early tensile strength and patency are excellent, but that long-term
aneurysm
formation is excessive. In addition, CO2 laser injury of the arterial intima
leads to a marked increase in atheromata formation in animal models of
atherosclerosis; this may be eliminated with the excimer laser. We have
begun
using the excimer laser to open obstructed peripheral and coronary arteries.
New
technology is emerging which allows dual fiber catheters which allow
identification of tissue in an artery, ie calcium, atheromata, clot, media,
etc.
and instantaneous computer sensing/integration which initiates
"fire" or "no
fire" signals in the enclosed laser system, thus decreasing the chance
of vessel
perforation. These technologies, in association with balloon angioplasty,
intravascular stents, and atherectomy devices are offering exciting
alternate
therapy for patients with obstructing atherosclerosis.
Publication Types:
Review
Review, Tutorial
PMID: 2084286 [PubMed - indexed for MEDLINE]
362: Crit Care Clin. 1990 Jul;6(3):579-603.
Non-conventional techniques of ventilatory support.
Villar J, Winston B, Slutsky AS.
Department of Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada.
The non-conventional techniques for ventilatory support represent a new
approach
to the management of patients with respiratory failure. A large number of
studies indicate that these techniques can maintain adequate gas exchange
under
conditions in which the traditional concepts of gas transport no longer
hold. We
have reviewed the group of techniques, collectively called high frequency
ventilation (HFV), in which the tidal volumes are much less (1 to 5 ml per
kg)
than those observed during conventional mechanical ventilation. Although HFV
has
theoretical advantages in some clinical settings, it has been shown to be
superior to conventional mechanical ventilation in but a few. HFV appears to
provide adequate ventilation while still allowing access to tracheal and
laryngeal surgical fields. It has been successful during pneumonectomy, and
in
the treatment of bronchopleural fistulae. The relevance of tracheal
insufflation
(TRIO) of oxygen and constant flow ventilation (CFV) to the human clinical
setting is uncertain. TRIO may be useful to oxygenate patients who are
difficult
to intubate, or TRIO could be applied for ventilation of patients involved
in
mass casualties. Although CFV does not maintain normal levels of PaCO2 in
humans, it can provide adequate oxygenation. It might be clinically
applicable
during thoracic surgery, in which movement of the abdominal and thoracic
contents associated with conventional mechanical ventilation is undesirable.
During CFV, the lung is kept motionless with sufficient airway pressures to
maintain patency of airways and alveoli. CFV is useful as a tool for
studying
phenomena affected by breathing. The rationale for the use of an artificial
lung
during extracorporeal membrane oxygenation (ECMO) or extracorporeal carbon
dioxide removal with low positive pressure ventilation (ECCO2R-LFPPV) in the
treatment of acute respiratory failure is to provide temporary respiratory
function while the pulmonary lesion is being treated or is resolving. The
factors that most limit the usefulness of ECMO are not technical but relate
to
the ability of the lung to recover structurally and functionally after a
severe
insult. Poor survival figures in the published series of ECMO in adults
reflect
the gravity of illness prior to treatment. However, results in neonates have
been quite encouraging. ECCO2R allows less exposure of blood to the
extracorporeal circuit and avoids the reduction in pulmonary blood flow
associated with ECMO. Although the reported survival of adults with severe
acute
respiratory failure treated with ECCO2R is extremely promising, it is
important
to point out that none of the published reports are controlled, randomized
studies.(ABSTRACT TRUNCATED AT 400 WORDS)
Publication Types:
Review
Review, Tutorial
PMID: 2198997 [PubMed - indexed for MEDLINE]
363: Clin Chest Med. 1990 Jun;11(2):333-46.
Radiologic assessment after lung transplantation.
Herman SJ.
University of Toronto, Ontario, Canada.
Radiographic studies have a major role to play in patients undergoing lung
transplantation. A review of the findings associated with the reimplantation
response, acute rejection, bronchiolitis obliterans, ischemia-induced
air-way
complications, and cyclosporine-associated lymphoma, as well as the
pulmonary
and cardiac change following double lung transplantation, has been
presented. It
should also be kept in mind that this group of patients is also subject to
all
of the usual problems associated with thoracic surgery, such as infection,
atelectasis, pleural effusion, and pneumothorax, conditions for which
radiologic
assessment is crucial.
Publication Types:
Review
Review, Tutorial
PMID: 2189667 [PubMed - indexed for MEDLINE]
364: J Thorac Imaging. 1990 Apr;5(2):1-7.
The microbiology, chemotherapy, and surgical treatment of tuberculosis.
Boyars MC.
Department of Internal Medicine, University of Texas Medical Branch,
Galveston
77550.
Tuberculosis is a disease that has plagued humankind for centuries. The
"white
plague" is not only treatable and curable but also preventable.
Initially,
tuberculosis fell in the province of the general physician. With the advent
of
technologic advances in thoracic surgery, surgical management of
tuberculosis
was brought to the forefront. Effective bactericidal drug therapy became
available by 1954 after the development of streptomycin in 1945 and
isoniazid in
1952. Additional effective antituberculous drugs have relegated surgical
therapy
for tuberculosis to a relatively minor role.
Publication Types:
Review
Review, Tutorial
PMID: 2182899 [PubMed - indexed for MEDLINE]
365: J Surg Res. 1990 Feb;48(2):165-81.
Current status of surgical adhesives.
Lerner R, Binur NS.
Department of Surgery, Interfaith Medical Center, Brooklyn, New York.
Publication Types:
Review
Review, Tutorial
PMID: 2406505 [PubMed - indexed for MEDLINE]
366: J Cardiothorac Anesth. 1990 Feb;4(1):105-17.
The arterial-end-tidal CO2 difference during cardiothoracic surgery.
Fletcher R.
Department of Anesthesia, University Hospital, Lund, Sweden.
Publication Types:
Review
Review, Tutorial
PMID: 2131842 [PubMed - indexed for MEDLINE]
367: Ann Thorac Surg. 1990 Jan;49(1):14-25.
Technical and scientific advances in general thoracic surgery.
Skinner DB.
New York Hospital Cornell Medical Center, New York 10021.
Publication Types:
Review
Review, Academic
PMID: 2404469 [PubMed - indexed for MEDLINE]
368: Fetal Diagn Ther. 1990;5(3-4):153-64.
Thoraco-amniotic shunting.
Nicolaides KH, Azar GB.
Harris Birthright Research Centre for Fetal Medicine, Department of
Obstetrics
and Gynaecology, King's College Hospital School of Medicine, London, UK.
Thoraco-amniotic shunting was performed in 51 singleton pregnancies for
decompression and chronic drainage of fetal pleural effusions (n = 47),
pericardial effusion (n = 1), or pulmonary cysts (n = 3). Five fetuses had
chromosomal defects and in 4 the parents elected termination of pregnancy.
All
18 non-hydropic fetuses and 14 of the 28 with hydrops survived.
Thoraco-amniotic
shunting is useful for diagnostic evaluation and treatment of fetuses with
pathologic collection of intrathoracic fluid.
Publication Types:
Review
Review of Reported
Cases
PMID: 2130840 [PubMed - indexed for MEDLINE]
369: Clin Orthop. 1989 Oct;(247):67-73.
Malignant bone tumor management. 30 years of achievement.
Sweetnam R.
London Supraregional Bone Tumour Centre, Middlesex Hospital, London,
England.
Malignant bone tumor management has changed drastically over the last three
decades. Orthopedic surgery has been in the forefront of these major advances.
Amputation is now much less common than other forms of limb reconstruction.
Oncologists have come to play a much larger role than do radiotherapists.
Indeed, radiotherapy is seldom used now except for its undoubted value in
palliation. The development of adjuvant chemotherapy is now prolonging life,
assisting the surgeon in local resection, and almost certainly increasing
the
chances of survival. When one considers the valuable role of thoracic
surgery in
lung metastectomy and the advances in pathology, imaging, and the staging of
bone tumors, it can be seen there has been a revolutionary change in the
care of
those who suffer from primary malignancy of bone.
Publication Types:
Review
Review, Tutorial
PMID: 2676306 [PubMed - indexed for MEDLINE]
370: Surg Clin North Am. 1989 Oct;69(5):991-1006.
Pectoralis major muscle-musculocutaneous flap for chest-wall reconstruction.
Tobin GR.
Department of Surgery, University of Louisville, Kentucky.
Pectoralis major muscle and musculocutaneous flaps are the most frequently
selected for the ventral chest wall, sternum, and anterior mediastinum
because
of their proximity, reliability, and versatility. These advantages are
derived
from consistent anatomic features that allow knowledgeable surgeons to use a
variety of flap designs tailored to defect needs. The flaps can be
transferred
on either thoracoacromial or internal mammary vascular pedicles and can be
segmentally split to achieve defect closure while retaining portions of the
muscle in situ to preserve donor motor function and surface form. The
musculocutaneous paddles can be placed in a variety of locations and
extended
beyond the muscle borders to meet specific defect needs. This anatomic
versatility gives pectoralis major muscle and musculocutaneous flaps a most
useful role in the reconstruction of defects of the sternum and anterior
mediastinum, defects of the ventral and lateral chest wall, and
intrathoracic
defects such as empyema cavities and bronchopleural fistula. A detailed
knowledge of surgical anatomy is essential for optimal application of these
flaps in the full spectrum of clinical needs.
Publication Types:
Review
Review, Tutorial
PMID: 2675356 [PubMed - indexed for MEDLINE]
371: Surg Clin North Am. 1989 Oct;69(5):977-90.
Latissimus dorsi muscle-musculocutaneous flap in chest-wall reconstruction.
Moelleken BR, Mathes SA, Chang N.
Department of Surgery, School of Medicine, University of California, San
Francisco.
The latissimus dorsi is a versatile muscle that can be employed in a variety
of
situations requiring chest-wall reconstruction. Its anatomy is predictable
and
has within it flexibility for transposition to a number of locations based
on
its standard or reverse arcs of rotation. It can be transposed with a skin
island, and its length and bulk can be used effectively to provide durable
coverage for anterior or posterior defects. These factors make the
latissimus
dorsi an excellent choice for the reconstruction of complex chest-wall
defects.
Publication Types:
Review
Review, Tutorial
PMID: 2675355 [PubMed - indexed for MEDLINE]
372: Surg Clin North Am. 1989 Oct;69(5):965-76.
Use of prosthetic materials in chest-wall reconstruction. Assets and
liabilities.
McCormack PM.
Thoracic Service, Memorial Sloan-Kettering Cancer Center, New York, New
York.
Sparked by the experience during war time, our knowledge of how to handle
chest-wall defects has matured with the decades since the 1940s. Techniques
are
now available for reconstruction of large areas of the chest wall. The
materials
are readily available and can be adapted to fit any size and shape of
defect.
The disadvantages are few and correctable. This technique has been used to
restore chest continuity in patients whose tumors were resected for cure. It
has
also been used palliatively for patients with bleeding, ulcerative, or
infected
tumors of the chest wall and in those with known metastases elsewhere.
Removing
the malodorous mass from the chest wall provides excellent palliation and
should
be offered to patients to improve their quality of survival.
Publication Types:
Review
Review, Tutorial
PMID: 2675354 [PubMed - indexed for MEDLINE]
373: Surg Clin North Am. 1989 Oct;69(5):899-910.
Preoperative evaluation and general preparation for chest-wall operations.
Azarow KS, Molloy M, Seyfer AE, Graeber GM.
Walter Reed Army Medical Center, Washington, D.C.
Chest-wall reconstruction is a major procedure with a risk of
life-threatening
complications. Accurate preoperative assessment is therefore critical, as it
allows detection and treatment of correctable problems and permits the
surgeon
to individualize postoperative management. Risk factors may be
cardiovascular,
pulmonary, or nutritional. The guiding principle of planning for the
reconstruction is that there must be absolutely no tension at the site of
the
full-thickness defect in the chest wall.
Publication Types:
Review
Review, Tutorial
PMID: 2675351 [PubMed - indexed for MEDLINE]
374: Surg Clin North Am. 1989 Oct;69(5):1081-9.
Reconstruction of the radiation-damaged chest wall.
Arnold PG, Pairolero PC.
Section of Plastic and Reconstructive Surgery, Mayo Medical School,
Rochester,
Minnesota.
In the patient with a radiation ulcer of the chest wall, the first question
is
whether the lesion contains persistent or recurrent cancer. It is also
important
to determine whether any other local problems such as mediastinal abscess
may
interfere with the reconstruction. Whether or not cancer is present, all
nonviable tissue must be removed. If cancer is not present, and a partial
thickness of the chest remains, the authors prefer transposition of the
greater
omentum for repair. If cancer is present, the physiologic defect resulting
from
cancer resection and wound debridement is far more severe, and a muscle or
musculocutaneous flap usually is appropriate. The pectoralis major,
latissimus
dorsi, external oblique, rectus abdominis, and trapezius muscles have been
utilized; the authors most often use the pectoralis or latissimus muscles.
Publication Types:
Review
Review, Tutorial
PMID: 2675349 [PubMed - indexed for MEDLINE]
375: Surg Clin North Am. 1989 Oct;69(5):1047-59.
Erratum in:
Surg Clin North Am
1990 Feb;70(1):vi.
Intrathoracic transfer of flaps for fistulas, exposed prosthetic devices, and
reinforcement of suture lines.
Pairolero PC, Arnold PG.
Section of General Thoracic Surgery, Mayo Medical School, Rochester,
Minnesota.
Intrathoracic infection associated with actual or potential leakage of the
airway, esophagus, heart, and great vessels is a life-threatening situation
that
is seen infrequently. Failure to control these infections with the usual
techniques often can be attributed to the presence of a persistent pleural
space
and continuing empyema. Intrathoracic transposition of extrathoracic
skeletal
muscle in these situations offers an effective method of management.
Publication Types:
Review
Review, Tutorial
PMID: 2675347 [PubMed - indexed for MEDLINE]
376: Surg Clin North Am. 1989 Oct;69(5):1103-18.
Reconstruction of congenital chest-wall deformities.
Garcia VF, Seyfer AE, Graeber GM.
George Washington University School of Medicine, Washington, D.C.
Pectus deformities and Poland's syndrome are two relatively common
congenital
deformities of the chest wall that are amenable to reconstruction. The
extent of
the structural deformity in pectus deformity and the degree of associated
cardiopulmonary dysfunction are critical variables in preoperative
assessment.
The operative approaches range from more extensive sternal eversion to the
more
popular subperichondrial cartilage resection with or without internal
fixation.
In Poland's syndrome, the options for reconstruction include anterior
transfer
of the ipsilateral latissimus dorsi muscle through a transaxillary tunnel
and
attachment to the clavicle and sternum. Submuscular insertion of a mammary
prosthesis can be added in the female patient.
Publication Types:
Review
Review, Tutorial
PMID: 2551052 [PubMed - indexed for MEDLINE]
377: Surg Clin North Am. 1989 Oct;69(5):1007-27.
Rectus abdominis muscle-musculocutaneous flap in chest-wall reconstruction.
Coleman JJ 3rd, Bostwick J.
Emory University School of Medicine, Atlanta, Georgia.
The rapid development of postmastectomy breast reconstruction has shown that
the
rectus abdominis muscle is a useful carrier for abdominal wall skin.
Detailed
analysis of the vascular anatomy of the abdominal wall has extended the uses
of
the transverse rectus abdominis musculocutaneous flap to major chest-wall
reconstruction, both as a transposition flap and as a free-tissue transfer.
Although the most direct pathway to the paraumbilical perforators that
supply
the large skin island of the flap is from the deep inferior epigastric
artery,
numerous collateral pathways exist from above that recruit blood from the
intercostal vessels and the internal mammary artery even if it has been
ligated
or used for myocardial revascularization. Awareness of these collateral
pathways
and care to preserve them whenever possible, combined with the willingness
to
supplement blood flow with a microvascular anastomosis of the deep inferior
epigastric vessels, allows the surgeon to use the rectus abdominis flap and
its
variations in almost any major chest-wall reconstruction (Fig. 11).
Publication Types:
Case Reports
Review
Review, Tutorial
PMID: 2528831 [PubMed - indexed for MEDLINE]
378: Eur Heart J. 1989 Jul;10(7):670-5.
Symptomatic congenital complete absence of the left pericardium. Case report
and
review of the literature.
Gehlmann HR, van Ingen GJ.
Onze Lieve Vrouwe Gasthuis, Amsterdam, Holland.
A fully documented case of complete absence of the left pericardium in a
44-year-old male is presented. Complaints of acute chest pain were caused by
strangulation of the heart between the pulmonary ligament and the diaphragm.
Preoperative electrocardiogram, chest X-ray and echocardiography showed
'classic' signs as described in the literature. A CAT scan suggested absence
of
the left pericardium, the definitive diagnosis was made with the aid of
thoracoscopy. This case of total absence of the left pericardium is the
first
documented one requiring thoracic surgery. The defect was closed through a
left-lateral thoracotomy using an allograft of pig pericardium.
Publication Types:
Case Reports
Review
Review of Reported
Cases
PMID: 2670568 [PubMed - indexed for MEDLINE]
379: Dimens Oncol Nurs. 1989 Winter;3(4):14-7.
Case studies in thoracic surgery.
Shuey KM.
Publication Types:
Case Reports
Review
Review, Tutorial
PMID: 2700427 [PubMed - indexed for MEDLINE]
380: Acta Chir Scand Suppl. 1989;550:159-65; discussion 165-8.
The influence of anesthesia and postoperative analgesic management of lung
function.
Sydow FW.
Stadtische Kliniken Kassel, Zentrale Abteilung fur Anasthesie, West Germany.
General anesthesia itself may influence postoperative lung function. It
leads to
a depression of the functional residual capacity, which, in combination with
surgical trauma and postoperative pain, can provoke insufficient breathing,
retention of bronchial secretions, and atelectasis. Regional anesthesia has
no
influence on lung function. After upper abdominal or thoracic surgery,
postoperative epidural analgesia causes a significant increase of lung
function
as compared with systemic analgesia. The combination of regional anesthesia
and
general anesthesia intraoperatively appears to reduce lung function much
less
than general anesthesia alone.
Publication Types:
Review
Review, Tutorial
PMID: 2652967 [PubMed - indexed for MEDLINE]
381: Acta Anaesthesiol Scand Suppl. 1989;90:5-12.
In what respect does high frequency positive pressure ventilation differ
from
conventional ventilation?
Sjostrand UH.
Department of Anesthesiology, University Hospital, Uppsala, Sweden.
The original rationale for HFPPV was that under certain conditions adequate
alveolar ventilation could be achieved with high ventilatory frequencies and
small tidal volumes. It was theorized further that increased ventilatory
frequencies and low tidal volumes would decrease the airway pressures,
barotrauma, and cardiovascular and other systemic consequences seen with
conventional mechanical ventilation. The first clinical applications of
HFPPV
were in bronchoscopy and laryngoscopy for diagnostic and/or therapeutic
purposes. Apart from these endoscopic applications, volume-controlled HFPPV
has
been compared with conventional ventilation in upper abdominal surgery and
coronary artery bypass grafting. The possible advantages of HFPPV over
conventional volume-controlled ventilation in the intensive care setting are
still unclear. Provided that the mean lung volumes are similar, oxygenation
in
acute respiratory failure is similar with both ventilation methods. Although
the
role of HFPPV in the management of pulmonary diseases still remains to be
clarified, it does provide effective ventilation in selected types of
patients
needing ventilatory support. New modes of pressure-controlled ventilation
have
not resolved all clinical problems in severe ARDS and/or acute respiratory
failure. The search for means of optimal ventilatory support with minimal
complications must continue, as conventional ventilation does not always
offer
the best treatment.
Publication Types:
Review
Review, Tutorial
PMID: 2648739 [PubMed - indexed for MEDLINE]
382: S Afr J Surg. 1988 Dec;26(4):153-60.
Preliminary results and rationale for the use of intrathecal papaverine for
the
prevention of paraplegia after aortic surgery.
Svensson LG, Stewart RW, Cosgrove DM, Lytle BW, Beven EG, Furlan AJ,
Gottlieb
AJ, Grum DF, Lewis BS, Salgado A, et al.
Publication Types:
Review
Review of Reported
Cases
PMID: 3062821 [PubMed - indexed for MEDLINE]
383: Ann Thorac Surg. 1988 Jul;46(1):4-12.
Operative management of chest wall deformities in children: unique
contributions
of Southern thoracic surgeons.
Haller JA Jr.
Department of Surgery, Johns Hopkins University School of Medicine,
Baltimore,
MD 21205.
Publication Types:
Historical Article
Review
Review, Tutorial
PMID: 3289518 [PubMed - indexed for MEDLINE]
384: Scand J Thorac Cardiovasc Surg. 1988;22(1):93-5.
Chylothorax as a complication of aortocoronary bypass. Two case reports and
a
review of the literature.
Zakhour BJ, Drucker MH, Franco AA.
Department of Surgery, St. Elizabeth Hospital Medical Center, Youngstown,
Ohio.
Iatrogenic chylothorax is a well-recognized complication following thoracic
surgery, but is a rare occurrence after aortocoronary bypass. Only two cases
have been previously reported. Two additional cases from our hospital are
presented. All four male patients responded to conservative management
within
two weeks of initiation of treatment. Only 12 cases of chylothorax following
median sternotomy have been reported (nine women and three men). Five of the
nine women required surgical exploration after a course of unsuccessful
management ranging from 14 to 26 days. The cause of the chylothorax was
considered to be injury to lymphatic collaterals in the anterior
mediastinum,
which resulted in a retrograde chyle flow; the main duct remained intact.
This
article reviews the normal anatomy of the thoracic duct and variations of
chylothorax, and describes the mechanism of injury in aortocoronary bypass,
the
prevention of this complication, and the results of treatment.
Publication Types:
Case Reports
Review
Review of Reported
Cases
PMID: 3291103 [PubMed - indexed for MEDLINE]
385: Semin Roentgenol. 1988 Jan;23(1):9-31.
Radiology of the chest after thoracic surgery.
Spirn PW, Gross GW, Wechsler RJ, Steiner RM.
Department of Radiology, Hahnemann University Hospital, Philadelphia, PA.
Publication Types:
Review
Review, Tutorial
PMID: 3281272 [PubMed - indexed for MEDLINE]
386: Crit Care Clin. 1987 Apr;3(2):287-306.
Pulmonary physiology in the postoperative period.
Fairshter RD, Williams JH Jr.
Department of Medicine, University of California Irvine, Orange.
After upper abdominal or thoracic surgery, loss of lung volume, manifested
most
importantly by reduced FRC, and abnormal gas exchange, manifested by
postoperative reduction in PaO2, are the rule rather than the exception.
These
physiologic alterations in lung function occur in the absence of
superimposed
complications such as pneumonia and/or lobar atelectasis; the usual
physiologic
alterations do, in fact, predispose to pulmonary complications (approximate
20
per cent incidence) which, when present, further compromise lung function.
The
mechanisms of postoperative impairment in lung function are multiple,
interactive, and at the present, incompletely understood. An attempt to
summarize the more important causes of impaired postoperative lung function
is
shown in Figure 6.
Publication Types:
Review
Review, Academic
PMID: 3332201 [PubMed - indexed for MEDLINE]
387: Vet Clin North Am Small Anim Pract. 1987 Mar;17(2):469-97.
Anesthetic management of thoracotomy.
Faggella AM, Raffe MR.
Successful anesthesia for thoracic surgery requires an understanding of the
clinical disease and the physiologic changes accompanying the disease, as
well
as anesthetic agents available for use. The authors discuss selection of
appropriate anesthetic drugs, perioperative management considerations,
pharmacologic support, intraoperative monitoring and postoperative pain
management.
Publication Types:
Review
PMID: 3554715 [PubMed - indexed for MEDLINE]
388: Vet Clin North Am Small Anim Pract. 1987 Mar;17(2):431-47.
Management of thoracic trauma and chest wall reconstruction.
Spackman CJ, Caywood DD.
This article reviews common causes and types of thoracic trauma in the dog.
A
triage approach for the diagnosis and immediate treatment of thoracic trauma
is
presented. Reconstructive procedures of the thoracic wall, which may be
necessary following trauma or surgical resection of diseased tissue, are
described.
Publication Types:
Review
PMID: 3554713 [PubMed - indexed for MEDLINE]
389: Radiology. 1987 Mar;162(3):639-43.
Lung torsion: case report and literature review.
Moser ES Jr, Proto AV.
A 65-year-old woman with endobronchial carcinoma had torsion of the left
upper
lobe. A posteroanterior chest radiograph showed apparent atelectasis in the
left
upper lobe, but the lateral view disclosed an inappropriate posterior
displacement of the collapsed lobe. The vasculature of the affected area
showed
an unusual curvature. Review of 21 examples of lung torsion disclosed no
characteristic age, sex, or affected lobe. The most common associations were
with previous surgery (n = 10) or a history of trauma (n = 5). The most
common
radiographic findings are opacification of the affected lobe (n = 12), an
abnormal vascular pattern (n = 6), and an abnormal location for the
atelectatic
lung (n = 5). Affected lobes often show hemorrhagic infarction or necrosis.
Publication Types:
Case Reports
Review
PMID: 3544030 [PubMed - indexed for MEDLINE]
390: J Vasc Surg. 1987 Mar;5(3):518-23.
Pathophysiology and prevention of acute renal failure associated with
thoracoabdominal or abdominal aortic surgery.
Miller DC, Myers BD.
Department of Cardiovascular Surgery, Stanford University School of
Medicine, CA
94305.
Publication Types:
Review
Review, Tutorial
PMID: 3334683 [PubMed - indexed for MEDLINE]
391: Resuscitation. 1987 Mar;15(1):23-35.
Emergency department thoracotomy for trauma: a collective review.
Ivatury RR, Rohman M.
A decade of experience with resuscitative thoracotomy for the trauma victim
in
extremis has been gained since the pioneering efforts of Mattox and his
associates in 1974. It appears, from a review of the various reports from
different trauma centers, that there is an emergence of a consensus as to
the
best indications for the procedure. It is generally agreed upon that ERT is
fruitless in the patient with severe head trauma or when vital signs were
absent
at the scene of the injury. In the absence of penetrating thoracic injuries
ERT
yields a very poor survival in patients without vital signs on admission to
the
emergency center. It is widely accepted that the best results for ERT are in
patients with cardiac tamponade. The prognosis is hopeless in patients
without
vital signs after sustaining blunt trauma.
Publication Types:
Review
PMID: 3035668 [PubMed - indexed for MEDLINE]
392: Chest. 1987 Feb;91(2):258-64.
Chest tubes. Indications, technique, management and complications.
Miller KS, Sahn SA.
Publication Types:
Review
PMID: 3542404 [PubMed - indexed for MEDLINE]
393: Hosp Pract (Off Ed). 1986 Dec 15;21(12):88C-88T, 88Y-88Z, 88DD.
Hypercoagulable states and venous thrombosis.
Haake DA, Berkman SA.
Many factors predispose patients to thromboembolic disease. A young person
presenting with idiopathic deep venous thrombosis may never have its
etiology
elucidated, despite exhaustive testing. On the other hand,
hypercoagulability is
no mystery in an obese, bedridden, postoperative patient with a malignancy.
Invasive or noninvasive testing should be performed in all suspicious cases.
Patients with positive results should be treated promptly; those with
negative
findings should not be subjected to anticoagulation. The length of
anticoagulation depends on the length of time the patient remains at risk of
thrombosis and may vary from months to a lifetime. Patients over 40 should
receive prophylactic minidose heparin for abdominal and thoracic surgery.
Patients undergoing hip surgery require some form of anticoagulation--be it
heparin, warfarin, aspirin, or dihydroergotamine-heparin. Because of lower
morbidity and superior long-term efficacy, transvenous devices are favored
over
surgical techniques for inferior vena caval interruption.
Publication Types:
Review
PMID: 3098759 [PubMed - indexed for MEDLINE]
394: Aust N Z J Surg. 1986 Oct;56(10):743-7.
Prediction of postoperative complications by clinical and nutritional
assessment.
Katelaris PH, Bennett GB, Smith RC.
This study evaluated a battery of nutritional measures and pre-operative
clinical assessment as predictors of postoperative morbidity. Fifty-seven
consecutive patients about to undergo major elective abdominal or thoracic
surgery were surveyed. Thirty-two per cent of patients had three or more
abnormal measurements of nutritional indices. Thirty patients had a total of
52
complications and in 12 patients these were major. The Prognostic
Nutritional
Index (PNI), formulated by Mullen, was found to be the best predictor of
postoperative outcome. It identified 10 of 12 (83%) patients who
subsequently
developed major complications with a specificity of 73%. Clinical assessment
selected six of the 12 patients who developed major complications.
Publication Types:
Review
PMID: 3533022 [PubMed - indexed for MEDLINE]
395: Emerg Med Clin North Am. 1986 Aug;4(3):459-65.
Emergency thoracotomy.
Krome RL, Dalbec DL.
Emergency thoracotomy is a valuable therapeutic modality for the moribund
patient when trauma is the cause of the shock state. It is a procedure that
requires an understanding of the technique and indications and should be
instituted based on the indications listed above. There is probably no
reason to
do this procedure in the patient who is in extremis as a result of blunt
trauma,
because results have been universally dismal in these patients. In the
patient
with a rapidly expanding abdomen resulting from trauma and who is moribund,
opening the chest and cross-clamping the aorta may be beneficial. Emergency
thoracotomy does not take the place of volume replacement and definitive
surgical care for the trauma patient.
Publication Types:
Review
PMID: 3522200 [PubMed - indexed for MEDLINE]
396: Can Anaesth Soc J. 1986 May;33(3 Pt 2):S28-37.
Anaesthesia for thoracic surgery: recent advances.
Benumof JL.
Publication Types:
Review
PMID: 3521802 [PubMed - indexed for MEDLINE]
397: Am J Emerg Med. 1986 May;4(3):248-58.
Open-chest cardiopulmonary resuscitation.
Rosenthal RE, Turbiak TW.
Publication Types:
Review
PMID: 3516165 [PubMed - indexed for MEDLINE]
398: Int Anesthesiol Clin. 1986 Spring;24(1):75-92.
High frequency ventilation.
Babinski MF, Smith RB.
Publication Types:
Review
PMID: 3512455 [PubMed - indexed for MEDLINE]
399: Anesth Analg. 1985 Aug;64(8):821-33.
One-lung ventilation and hypoxic pulmonary vasoconstriction: implications
for
anesthetic management.
Benumof JL.
Publication Types:
Review
PMID: 3893223 [PubMed - indexed for MEDLINE]
400: Surg Clin North Am. 1985 Jun;65(3):539-51.
Creatine kinase (CK): its use in the evaluation of perioperative myocardial
infarction.
Graeber GM.
Establishing the diagnosis of acute perioperative myocardial infarction by
the
mere presence of a serum CK-MB band alone is not valid. Laboratory
investigations have shown that tissues other than ventricular myocardium
hold
appreciable quantities of CK-MB. Moreover, each of the laboratory methods
commonly used for measuring serum total CK and its isoenzymes have inherent
strengths and weaknesses. Hence, accurate evaluation of perioperative CK-MB
bands requires determination of the amplitude and the temporal course of the
elevation. Confirmation of the CK-MB findings by analysis of another enzyme
system is advisable. Serum lactate dehydrogenase isoenzymes can fulfill this
role. Institution of a dual enzyme evaluation is achieved easily in most
hospitals and can yield a very high degree of sensitivity and specificity.
The
final step in diagnostic accuracy is completed by continuing evaluation of
the
enzyme diagnostic system in each individual institution.
Publication Types:
Review
PMID: 3898430 [PubMed - indexed for MEDLINE]
401: Crit Care Med. 1985 Jan;13(1):49-52.
Chylothorax review.
Teba L, Dedhia HV, Bowen R, Alexander JC.
Chylous leakage from the thoracic duct into the pleural space may occur
after
any type of thoracic surgery; however, there are few reports of this
condition
after coronary artery bypass grafting. A case of chylothorax after combined
coronary bypass and mitral valve replacement is reported to illustrate a
discussion of its pathologic basis, diagnosis and management.
Publication Types:
Case Reports
Review
PMID: 3917388 [PubMed - indexed for MEDLINE]
402: Pharmacotherapy. 1984 Sep-Oct;4(5):248-71.
Surgical antimicrobial prophylaxis: principles and guidelines.
Burnakis TG.
Antimicrobial prophylaxis for surgical procedures is an area that is
recognized
as being subject to individual clinical variations. This review gives
practitioners some basic principles of rational prophylaxis as defined by
the
medical literature. In addition, this literature is evaluated and condensed
to
provide clinicians with guidelines for particular procedures: obstetric,
gynecologic, gastric, biliary, colonic, urologic, cardiac, thoracic,
vascular,
orthopedic and head and neck. Each section concludes with recommendations
for
the clinically most accepted prophylactic regimens. Antibiotics discussed
include not only the older agents, but where good information exists, the
newer
cephalosporins. The suggested regimens consider efficacy, safety and cost as
determinants in rational prescribing. Although research into even shorter,
and
perhaps more cost-effective, regimens continues, this compilation lists
state-of-the-art recommendations.
Publication Types:
Review
PMID: 6438611 [PubMed - indexed for MEDLINE]
403: J Ky Med Assoc. 1984 Aug;82(8):369-73.
Spontaneous pneumothorax. A 28-year review.
Mayo P.
Publication Types:
Review
PMID: 6384397 [PubMed - indexed for MEDLINE]
404: Surg Clin North Am. 1983 Dec;63(6):1259-68.
Complications of thoracic surgery. Avoidance and recognition.
Kakos GS.
Publication Types:
Review
PMID: 6359501 [PubMed - indexed for MEDLINE]
405: Surg Clin North Am. 1983 Oct;63(5):1069-79.
Respiratory care of the surgical patient with cardiac disease.
Tantum KR.
This article describes the mechanisms by which cardiac disease, when
combined
with surgery and anesthesia, may tax the respiratory system beyond its
capabilities. Techniques of respiratory support aimed at improving
oxygenation,
ventilation, and the work of breathing are examined.
Publication Types:
Review
PMID: 6138863 [PubMed - indexed for MEDLINE]
406: Clin Chest Med. 1983 Sep;4(3):443-63.
Surgical management of emphysema.
Gaensler EA, Cugell DW, Knudson RJ, FitzGerald MX.
The history of surgery for the treatment of emphysema and its complications
is
long and complex and, with improved understanding of the pathophysiology,
most
procedures have been discarded. Present clear indications for surgery are
mainly
large or increasing bullae that result in compression of apparently good
lung
tissue, and complications of bullous emphysema such as pneumothorax and
infection. With localized giant bullae the results of local resection can be
as
dramatic as the effects of pleural drainage for tension pneumothorax.
Lobectomy
should not be undertaken until bullae have been removed locally and
application
of positive pressure has failed to reveal any expandable lung tissue--a rare
situation. Resection of small bullae generally has no effect on lung
function.
The indications for resection of large bullae in the presence of diffuse
emphysema require careful individual study. In such cases even a small
increment
of function may be of great clinical benefit, and there is evidence that
longevity can be increased. Finally, two-stage local drainage of tension
bullae
may be indicated in those rare cases in which open thoracotomy cannot be
considered for other reasons.
Publication Types:
Review
PMID: 6357604 [PubMed - indexed for MEDLINE]
407: Emerg Med Clin North Am. 1983 Aug;1(2):431-48.
Pneumothorax, hemothorax, and other abnormalities of the pleural space.
Vukich DJ.
The clinical setting and treatment of various types of pneumothorax are
detailed; chylothorax and hemothorax are also discussed. Tube thoracostomy,
which can be performed with basic surgical skills if attention is paid to
potential complications and optimal technique, is described.
Publication Types:
Review
PMID: 6394296 [PubMed - indexed for MEDLINE]
408: JAMA. 1983 Apr 8;249(14):1891-6.
Emergency thoracotomy in the management of trauma.
Bodai BI, Smith JP, Ward RE, O'Neill MB, Auborg R.
The role of emergency room thoracotomy in the management of trauma remains
poorly defined despite an increase in its use. Most authors agree that the
procedure is effective in the treatment of penetrating thoracic injuries, while
its benefit in penetrating injuries below the diaphragm and in blunt trauma
has
not been established. The best outcome can be expected in patients who have
sustained penetrating cardiac and thoracic injuries. Penetrating abdominal
wounds that are severe enough to require thoracotomy in the emergency room
fare
less well; those patients who suffer from blunt thoracoabdominal injuries
are
least fortunate. The anatomic location and mode of injury greatly influence
the
outcome of these patients and are useful in determining when to perform this
procedure.
Publication Types:
Review
PMID: 6339752 [PubMed - indexed for MEDLINE]
409: Surg Clin North Am. 1983 Apr;63(2):417-38.
Mechanical ventilatory support.
Hotchkiss RS, Wilson RS.
Publication Types:
Review
PMID: 6407127 [PubMed - indexed for MEDLINE]
410: Curr Probl Surg. 1983 Feb;20(2):69-132.
The prophylactic use of antimicrobials in surgery.
Dipiro JT, Bivins BA, Record KE, Bell RM, Griffen WO Jr.
During the period August 1976 to June 1982, there were 98 reports of
antimicrobial prophylaxis in human surgery that were judged unevaluable. Our
review, coupled with that of Chodak and Plaut, identified studies of 126
antibiotic regimens that were considered evaluable and a total of 205
studies
considered unevaluable. A decrease in infection rate in antibiotic-treated
patients compared to non-antibiotic-treated patients was seen in 120 (95%)
of
the evaluable regimens. Ninety-nine (79%) of these 120 regimens produced
statistically significant reductions in the infection rate (P less than .05,
chi
2 analysis). The majority of the antibiotic regimens were tested in
procedures
that were classified as clean-contaminated. Of the regimens that yielded a
statistically significant reduction in infection rate with antimicrobial
therapy, in 66 (67%) the agents were used for 24 hours or less. Five
regimens
were identified in which a higher infection rate occurred in specific
patient
groups when prophylactic antibiotics were used, but the differences were not
statistically significant. In the overwhelming majority of evaluable
studies,
antibiotics decreased the incidence of surgical infection compared with
non-antibiotic groups. The available data also support the effectiveness of
short prophylactic antibiotic courses of 24 hours' duration or less. The
duration necessary for antibiotic prophylaxis was specifically tested in
nine
regimens. In all nine, a short course (less than 24 hours) of antibiotic
prophylaxis was as effective as longer periods of therapy (24 hours to 5
days)
in preventing infection.
Publication Types:
Review
PMID: 6337785 [PubMed - indexed for MEDLINE]
411: J Am Geriatr Soc. 1983 Feb;31(2):99-102.
Estimation of surgical risk in the elderly: a correlative review.
Mohr DN.
Age continues to be a risk factor for overall mortality in elective and
emergency surgical procedures. Postoperative pneumonias, life-threatening
cardiac complications, and malignancy-related complications account for most
deaths. Heart disease, dementia, and diabetes confer an additional surgical
risk
for elderly patients. Careful preoperative assessment, however, can
categorize
elderly patients into groups that are at no additional risk. Factors other
than
age should be considered in estimating surgical risk in the elderly.
Publication Types:
Review
PMID: 6337206 [PubMed - indexed for MEDLINE]
412: Acta Anaesthesiol Scand. 1982 Jun;26(3):279-86.
Respirators and respiratory care.
Bendixen HH.
The intellectual and technological roots of respirators and respiratory care
may
be traced back hundreds of years. The clinical evolution has taken the
better
part of a century, and it has been most closely linked to the development of
open-chest surgery. Resuscitation and the treatment of poliomyelitis also
have
contributed ideas and technology to this evolution. If its successful
performance had depended only on respirators, open-chest surgery would have
become clinical routine 50-80 years ago. In fact, many factors had to be
under
control, many modes of treatment had to be available, before the
breakthrough in
open-chest surgery could occur. The most important factor may have been the
effective control of sepsis and hemorrhage. Open-chest surgery forced the
change
from single-agent deep anesthesia with spontaneous ventilation to a balanced
technique, using multiple drugs or agents, with controlled ventilation.
Open-chest surgery also necessitated that physicians specialize in
anesthesiology. Scandinavian scientists and physicians have contributed
greatly
to the field of respirators and respiratory care, as has the specialty of
anesthesiology.
Publication Types:
Historical Article
Review
PMID: 7051733 [PubMed - indexed for MEDLINE]
413: Drug Ther. 1982;:17-36.
Systemic antimicrobial prophylaxis in surgery.
Hirschmann JV.
Publication Types:
Review
PMID: 6809441 [PubMed - indexed for MEDLINE]
414: Surg Clin North Am. 1981 Oct;61(5):1199-207.
Diagnosis and operative management of chest wall deformities in children.
Haller JA Jr, Turner CS.
Publication Types:
Review
PMID: 7031930 [PubMed - indexed for MEDLINE]
415: Can Anaesth Soc J. 1981 Jul;28(4):305-13.
Pulmonary atelectasis after anaesthesia: pathophysiology and management.
Rigg JR.
The pathophysiological basis of pulmonary atelectasis is reviewed and risk
factors that enhance lung collapse are discussed. Management strategies to
reduce or eliminate risk factors and to prevent collapse are discussed and
the
rational bases of these strategies are identified. Instability of lung
alveoli
is a consequence of surface tension and regional differences in alveolar
size.
The inherent tendency of alveoli to collapse is enhanced by the following
risk
factors; low lung volume, high closing volume, oxygen therapy, a rapid
shallow
ventilatory pattern, chronic lung disease, smoking, obesity, postoperative
pain
following abdominal or thoracic surgery, narcotic induced ventilatory
depression, and neurological, neuromuscular, muscular and musculoskeletal
diseases associated with mechanical impairment of respiratory function. The
primary goal of perioperative respiratory management is prevention of
atelectasis. Appropriate management strategies include physiotherapy and
delay
of elective surgery if substantial improvement in respiratory status can be
achieved by specific treatments such as antibiotics, bronchodilators,
steroids,
and reduction of tobacco use and caloric intake. In selected cases, elective
postoperative controlled ventilation may be indicated.
Publication Types:
Review
PMID: 6114789 [PubMed - indexed for MEDLINE]
416: Ann Thorac Surg. 1981 Feb;31(2):191-8.
Recent advances in the management of thoracic surgical infections.
Skinner DB, Myerowitz PD.
Current management of infections in thoracic surgery is reviewed. The
selection
of patients for the use of antibiotics prophylactically, the diagnosis and
treatment of pulmonary infection in immunosuppressed patients, indications
for
operation in patients with fungal infections, bronchiectasis, lung abscess,
and
empyema, and the management of mediastinitis after sternotomy and of
postpneumonectomy space infections is described.
Publication Types:
Review
PMID: 6779722 [PubMed - indexed for MEDLINE]
417: Major Probl Clin Surg. 1981;4:435-54.
Extrinsic arterial compression syndromes.
Gaspar MR.
Publication Types:
Review
PMID: 7029164 [PubMed - indexed for MEDLINE]
418: Int Anesthesiol Clin. 1981 Fall;19(3):123-67.
Hypoxemia and general anesthesia: an analysis of distribution of ventilation
and
perfusion.
Klineberg PL, Bagshaw RJ.
There is now overwhelming evidence that anesthesia with and without muscle
paralysis is associated with an increased inefficiency of gas exchange, with
abnormal oxygenation and CO2 elimination. There is great variation in the
degree
of this change from individual to individual; it results from increased
right-to-left intrapulmonary shunting, increased alveolar dead space,
increased
dispersion of VA/Q ratios, altered cardiac output, and changes of the ODC.
In
normal subjects the abnormality can be largely explained by mismatch of
ventilation and perfusion. Distribution of perfusion is determined by right
ventricular output, the distribution of pulmonary vascular impedance, and
their
mutual interaction. This interaction is specifically influenced by gravity,
right heart dynamics, systemic hemodynamics, particularly via the left
atrium,
and lung inflation. General anesthesia modifies the distribution of
perfusion,
largely to the extent that the above determinants are changed by: the
particular
anesthetic agents used; the posture adopted (gravity); the type and extent
of
ventilation employed; hypoxic pulmonary vasoconstriction; and any
accompanying
special techniques such as deliberate hypotension. Ventilation distribution
is
dependent on the posture of the subject and changes of the lung volumes and
mechanics, which probably result from altered chest wall and diaphragm
mechanics. These changes occur soon after induction of anesthesia and do not
appear to be progressive. They can persist, however, well into the postoperative
period. Alterations of pulmonary function during anesthesia and surgery are
rarely life threatening in the operating room. Awareness of the problems of
hypoxemia during general anesthesia and an appropriate response by the
anesthesiologist, however, is a prerequisite of good medical practice.
Publication Types:
Review
PMID: 7026450 [PubMed - indexed for MEDLINE]
419: N Engl J Med. 1980 Jul 24;303(4):200-2.
Current concepts: malignant mesothelioma.
Antman KH.
Publication Types:
Review
PMID: 6155613 [PubMed - indexed for MEDLINE]
420: Curr Probl Cardiol. 1980 May;5(2):1-41.
Management of cardiac disease in the general surgical patient.
Salem DN, Homans DC, Isner JM.
Publication Types:
Review
PMID: 6110512 [PubMed - indexed for MEDLINE]
421: Surg Gynecol Obstet. 1979 Sep;149(3):437-42.
Current status of surgery of the omentum.
Samson R, Pasternak BM.
The greater omentum is a unique organ with multipotential properties. A
simple
procedure converts it into a vascularized pedicle that may be utilized
throughout the body. Knowledge of the possible applications of free or
pedicled
omental grafts will significantly add to the armamentarium of a clinical and
experimental surgeon.
Publication Types:
Review
PMID: 382412 [PubMed - indexed for MEDLINE]
422: Major Probl Clin Surg. 1979;5:484-503.
Cancer of the breast. Local and regional recurrence.
Donegan WL.
Publication Types:
Review
PMID: 379455 [PubMed - indexed for MEDLINE]
423: Surg Gynecol Obstet. 1978 Sep;147(3):433-43.
Thoracoscopy in perspective.
Bloomberg AE.
The indications for thoracoscopy are undiagnosed pleural disease effusions
of
tumors; when tissue specificity is important for future treatment and
adequate
tissue is needed for estrogen binding studies; undiagnosed pleuropulmonary
disease; biopsy of pulmonary lesions undiagnosed by other means; mediastinal
masses, particularly in children; hilar masses; preoperative screening
preliminary to thoracotomy for resection in malignant disease, particularly
those with effusions; in spontaneous pneumothorax, to define the abnormality
and
indicate the need for thoracotomy; for postresection space problems; trauma,
and, of course, for intrapleural pneumonolysis.
Publication Types:
Historical Article
Review
PMID: 356308 [PubMed - indexed for MEDLINE]
424: Ann Intern Med. 1978 Apr;88(4):532-7.
Pleural effusion from malignancy.
Leff A, Hopewell PC, Costello J.
Pleural effusion from metastatic malignancy can cause major impairment of
respiratory function and eventual death. Although cure is not possible,
successful palliative treatment allows months to years of productive life,
obviating the need for continuous hospitalization and repeated
thoracenteses.
Successful palliative treatment requires obliteration of the pleural space.
Literature survey indicates that a wide variety of medical agents and
surgical
methods have been used with variable success. Medical methods include
instillation of antineoplastic agents, antimicrobial agents, or colloidal
radioisotopes into the pleural space; quinacrine and tetracycline are
moderately
to highly effective agents, but the toxicity of the former is substantial.
Bedside talc poudrage with thoracostomy-tube drainage is a safe and highly
effective alternative. Pleurectomy is the definitive method of preventing
reaccumulation of pleural fluid that results from metastatic malignancy,
even
when other methods have failed, but thehigh morbidity and mortality of the
procedures mandate careful patient selection.
Publication Types:
Review
PMID: 76455 [PubMed - indexed for MEDLINE]
425: Med Clin North Am. 1977 Nov;61(6):1205-18.
Lung cancer.
Rodescu D.
Only patients with localized lung cancer benefit from curative resection.
Curative radiotherapy is recommended in patients with a resectable tumor in
whom
surgery is precluded for medical reasons. Adjuvant preoperative or
postoperative
therapy of any type does not improve the results of surgery except in
patients
with Pancoast tumor. Therapy for nonlocalized tumors does not affect
survival.
Radiotherapy has a palliative effect in 50 to 75 per cent of patients
presenting
with symptoms from either a primary lesion or metastases and should
therefore be
recommended in symptomatic patients. The palliative effect of chemotherapy
is
limited in lung cancers other than small cell carcinomas. However,
chemotherapy
alone or in association with radiotherapy produces remarkable tumor
regression
and some improvement of survival in small cell carcinoma. The use of
immunotherapy in the treatment of lung cancer is still under evaluation.
Publication Types:
Review
PMID: 72894 [PubMed - indexed for MEDLINE]
426: Curr Probl Cancer. 1977 Oct;2(4):1-73.
Reconstructive surgery in the cancer patient.
Brown RG, Jurkiewicz MJ.
Publication Types:
Review
PMID: 336294 [PubMed - indexed for MEDLINE]
427: Postgrad Med. 1976 May;59(5):80-4.
Preventing pulmonary embolism with heparin in low doses.
Sherry S.
The introduction of low-dose heparin prophylaxis of thrombosis in deep leg
veins
represents a major advance in clinical medicine. It approaches an ideal form
of
prophylaxis in that it can be given easily to large numbers of patients at
risk,
requires no monitoring, is relatively safe, and, used widely, should save
many
lives. Conservative estimates are that 5,000 postoperative deaths and a
comparable number of medical deaths can be avoided in the United States
alone.
Further inroads on this important problem will require additional
developments,
some of which are well under way.
Publication Types:
Review
PMID: 772644 [PubMed - indexed for MEDLINE]
428: Pediatr Clin North Am. 1974 May;21(2):361-8.
Pediatric surgery. Current concepts.
Feins NR.
Publication Types:
Review
PMID: 4209645 [PubMed - indexed for MEDLINE]
429: Anaesth Intensive Care. 1974 Feb;2(1):33-42.
Cerebral effects of circulatory arrest at 20 degrees c in the infant pig.
Fisk GC, Wright JS, Turner BB, Baker Wde C, Hicks RG, Lethlean AK, Stacey
RB,
Lawrence JC, Lawrie GM, Kalnins I, Rose M.
Publication Types:
Review
PMID: 4604197 [PubMed - indexed for MEDLINE]
430: Circ Res. 1974 Jan;40(4):1-8.
Determination of left ventricular size and shape.
Sandler H, Alderman E.
Publication Types:
Review
PMID: 4588314 [PubMed - indexed for MEDLINE]
431: Ann Thorac Surg. 1973 Jan;15(1):94-101.
New diagnostic tests in thoracic surgery. A perspective.
Skinner DB.
Publication Types:
Review
PMID: 4581681 [PubMed - indexed for MEDLINE]
432: Int Rev Connect Tissue Res. 1973;6:1-61.
Medical and surgical applications of collagen.
Chvapil M, Kronenthal L, Van Winkle W Jr.
Publication Types:
Review
PMID: 4579316 [PubMed - indexed for MEDLINE]
433: Otolaryngol Clin North Am. 1972 Oct;5(3):435-46.
Reconstruction of the hypopharynx and cervical esophagus.
Leonard JR, Holt GP.
Publication Types:
Review
PMID: 4561212 [PubMed - indexed for MEDLINE]
434: Minn Med. 1972 Aug;55:Suppl 2:7-53.
The development of thoracic surgery in the upper Mid-West.
Kinsella TJ.
Publication Types:
Historical Article
Review
PMID: 4562542 [PubMed - indexed for MEDLINE]
435: Scott Med J. 1972 Apr;17(4):153-62.
Recent advances in plastic surgery.
Jackson IT.
Publication Types:
Review
PMID: 4557112 [PubMed - indexed for MEDLINE]
436: Int Anesthesiol Clin. 1972 Winter;10(4):41-59.
Pulmonary consequences of abdominal and thoracic surgery.
Spence AA, Alexander JI.
Publication Types:
Review
PMID: 4577301 [PubMed - indexed for MEDLINE]
437: Ann Thorac Surg. 1970 Dec;10(6):571-87.
Esophageal perforations.
Loop FD, Groves LK.
Publication Types:
Review
PMID: 4922006 [PubMed - indexed for MEDLINE]
438: Anaesthesia. 1970 Jan;25(1):87-104.
Cardiac pacemakers as an anaesthetic problem.
Scott DL.
Publication Types:
Review
PMID: 4905028 [PubMed - indexed for MEDLINE]
439: Surg Clin North Am. 1969 Apr;49(2):313-22.
Problems in chest wall resection.
Martini N, Starzynski TE, Beattie EJ Jr.
Publication Types:
Review
PMID: 4886905 [PubMed - indexed for MEDLINE]
440: Prog Surg. 1969;7:56-113.
Stapling devices and their use in surgery.
Guthy E, Brendel W.
Publication Types:
Review
PMID: 4891955 [PubMed - indexed for MEDLINE]
441: Mod Treat. 1969 Jan;6(1):26-46.
Problems of restrictive thoracopulmonary disease.
Snider GL.
Publication Types:
Review
PMID: 4885817 [PubMed - indexed for MEDLINE]
442: Ann Thorac Surg. 1968 Nov;6(5):484-502.
The surgical treatment of pulmonary tuberculosis.
Steele JD.
Publication Types:
Review
PMID: 4913486 [PubMed - indexed for MEDLINE]
443: Acta Chir Scand Suppl. 1967;378:71-5.
Proteinase inhibitors in thoracic surgery.
Nordstrom S.
Publication Types:
Review
PMID: 4865431 [PubMed - indexed for MEDLINE]
444: Br J Surg. 1966 Oct;53(10):848-51.
Thoracic surgery.
D'Abreu AL.
Publication Types:
Review
PMID: 5332117 [PubMed - indexed for MEDLINE]