MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Seminars in Thoracic and Cardiovascular Surgery' source. Tue, 16 Mar 2010 18:12:52 +0100 http://www.medworm.com/index.php?rid=3354134&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909001397%2Fabstract%3Frss%3Dyes This article reviews the current treatment of blunt thoracic aortic injury and the use of thoracic aortic stent grafting for this patient population. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3354134 Thu, 11 Mar 2010 18:09:36 +0100 3354134 http://www.medworm.com/index.php?rid=3354133&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS104306790900149X%2Fabstract%3Frss%3Dyes DeBakey type I aortic dissections pose significant challenges in operative and long-term management of the arch and distal thoracic aorta. Concerns regarding management of complex tears extending to the arch and descending thoracic aorta, malperfusion syndromes, and late aortic dilatation have provided an impetus to explore aortic repairs that involve stent-graft placement into the descending thoracic aorta in combination with conventional hemi-arch or total arch repairs. Early results with these techniques are promising but further study is warranted. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3354133 Thu, 11 Mar 2010 18:09:36 +0100 3354133 http://www.medworm.com/index.php?rid=3354132&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909001440%2Fabstract%3Frss%3Dyes Type III aortic dissection is associated with high morbidity and mortality. There is a shifting paradigm in the treatment of complicated and uncomplicated acute type III aortic dissection toward earlier endovascular repair. In this review, the authors present the current perspective on the endovascular management of acute complicated and uncomplicated type III aortic dissection. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3354132 Thu, 11 Mar 2010 18:09:36 +0100 3354132 http://www.medworm.com/index.php?rid=3354131&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909001415%2Fabstract%3Frss%3Dyes Endoleaks and endotension remain the primary limitation of endovascular aortic repair with stent-grafts. Consequently, all endovascular surgeons performing thoracic or abdominal endovascular aortic repairs require a comprehensive knowledge and understanding of how to survey and manage endoleaks. The derivation of the current endoleak classification scheme, the clinical impact of endoleaks, the diagnostic tools relevant to endoleak detection, an endoleak surveillance protocol, and the strategies in use for their management are outlined in this review. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3354131 Thu, 11 Mar 2010 18:09:36 +0100 3354131 http://www.medworm.com/index.php?rid=3354130&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909001464%2Fabstract%3Frss%3Dyes Thoracoabdominal aortic aneurysms (TAAA) remain a formidable surgical challenge, with conventional open repair associated with significant rates of mortality and morbidity. Furthermore, many of these patients are elderly with significant comorbidities and may not be candidates for repair. Consequently, the availability of a “hybrid” option, including open visceral debranching with concomitant endovascular aneurysm exclusion, may have advantages in these high-risk patients, including the potential to offer therapy to those ineligible for conventional repair. Our technique for hybrid TAAA repair is performed by means of midline laparotomy. A commercially manufactured custom multibranched Dacron graft is used to sequentially bypass, in extranatomic manner, the left renal artery, superior ... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3354130 Thu, 11 Mar 2010 18:09:36 +0100 3354130 http://www.medworm.com/index.php?rid=3354129&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909001439%2Fabstract%3Frss%3Dyes Surgical management of aortic arch aneurysms remains a clinical challenge associated with significant perioperative morbidity and mortality. For the increasingly aging population with significant comorbidities, innovative hybrid aortic arch reconstructive techniques using thoracic endograft technology have been developed in an attempt to improve surgical outcome. With these hybrid arch reconstructive techniques, surgeons have extended the indications and provided an alternative surgical option to patients previously considered prohibitively high risk for conventional open repair of aortic arch aneurysms. Multiple techniques have been described in the literature. In this section, we will present: (1) the current results of hybrid aortic arch repair and (2) a new classification based on the ... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3354129 Thu, 11 Mar 2010 18:09:36 +0100 3354129 http://www.medworm.com/index.php?rid=3354128&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909001488%2Fabstract%3Frss%3Dyes Descending thoracic aortic aneurysmal disease is associated with poor 5-year survival rates as low as 10%-15% if untreated. This is probable because of a combination of the aneurysmal disease, comorbidities, and in many patients advanced age. In the search for better outcomes and newer techniques, the endovascular approach for the treatment of these aneurysms has developed over the last 20 years. Many advances in the materials and techniques have been made since the first reports of abdominal and thoracic aortic endovascular repair in the early 1990s. Currently, clinical trials have proven that several different commercially available endovascular grafts can be deployed safely, with early results equal to or better than conventional open repairs. Most of the data reported have been on earl... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3354128 Thu, 11 Mar 2010 18:09:36 +0100 3354128 http://www.medworm.com/index.php?rid=3354127&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909001506%2Fabstract%3Frss%3Dyes Since US Food and Drug Administration approval in 2005 for the treatment of descending thoracic aortic aneurysms, thoracic endovascular aortic repair (TEVAR) has revolutionized the field of thoracic aortic surgery. Although no randomized studies exist to this point, accumulating clinical experience from around the world has confirmed the feasibility and the safety of this new treatment paradigm, with results comparable to conventional open repair. Furthermore, TEVAR provides patients previously considered prohibitively high risk for conventional repair an alternative surgical option. With its widespread acceptance in the treatment of aneurysmal disease, innovative investigators have further expanded the indications of use with off-label application of TEVAR in various other thoracic aortic... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3354127 Thu, 11 Mar 2010 18:09:36 +0100 3354127 http://www.medworm.com/index.php?rid=3354126&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909001385%2Fabstract%3Frss%3Dyes Improving existing means of sentinel lymph node identification in non-small cell lung cancer will allow for molecular detection of occult micrometastases that may cause recurrence in early stage non-small cell lung cancer. Furthermore, targeted application of chemical and biological cytotoxic agents can potentially improve outcomes in patients with lymph node (LN) metastases. “Therapeutic Sentinel Lymph Node Imaging” incorporates these modalities into a single agent thereby identifying which LNs harbor tumor cells and simultaneously eradicating metastatic disease. In this review, we summarize the novel preclinical agents for identification and treatment of tumor bearing LNs and discuss their potential for clinical translation. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3354126 Thu, 11 Mar 2010 18:09:36 +0100 3354126 http://www.medworm.com/index.php?rid=3354125&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909001403%2Fabstract%3Frss%3Dyes Radioguided lymph node mapping can potentially improve staging in locoregional non-small cell lung cancer. This is accomplished by using advanced pathologic techniques to detect micrometastases in selected thoracic lymph nodes. The use of isosulfan blue, technetium-99m and 18F-fluorodeoxyglucose (FDG) as mapping agents have been reported. Despite several limitations in this technique, it may facilitate the selection of patients for novel therapies, resulting in improved outcomes for lung cancer patients. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3354125 Thu, 11 Mar 2010 18:09:36 +0100 3354125 http://www.medworm.com/index.php?rid=3354124&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909001427%2Fabstract%3Frss%3Dyes In this study, the following topics regarding SN identification in lung cancer patients will be introduced: (1) devices for SN identification using a radioisotope tracer; (2) movement of Tc-99 tin colloid after injection; (3) characteristics of patients in whom SNs could not be identified; (4) results of ex vivo SN identification; (5) reliability of in vivo SN identification; (6) algorithm for reducing mediastinal lymph node dissection; (7) SN identification using SPECT/CT; (8) differences in SN identification between large and small radioisotope particles; (9) size of metastatic and nonmetastatic mediastinal lymph nodes in non-small cell lung cancer; (10) SN navigation segmentectomy for clinical stage IA non-small cell lung cancer; and (11) lymphatic flow at segmental lymph nodes. (Source... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3354124 Thu, 11 Mar 2010 18:09:36 +0100 3354124 http://www.medworm.com/index.php?rid=3354123&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909001452%2Fabstract%3Frss%3Dyes In this study, we discuss the potential for using the combination of invisible near-infrared (NIR) fluorescent light and nanotechnology for these applications. NIR fluorescence imaging has recently received significant attention for in vivo imaging applications because of its low tissue autofluorescence, high photon penetration into living tissue, and high signal-to-background ratio. Our large animal in vivo studies have been able to successfully identify SLNs in lung tissue, and several clinical studies have examined the use of NIR fluorescence imaging systems for SLN mapping in breast and gastric cancer. Promising new nanoparticle technologies, when combined with NIR fluorescence imaging, offer the potential for image-guided treatment of lymph nodes at high risk for tumor recurrence. Thi... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3354123 Thu, 11 Mar 2010 18:09:36 +0100 3354123 http://www.medworm.com/index.php?rid=3354122&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909001373%2Fabstract%3Frss%3Dyes The basic anatomic lymph node drainage patterns from lung cancers have remained relatively constant since their early descriptions. Sentinel lymph node mapping and other reviews of anatomic resections have provided additional information regarding drainage patterns of lymphatic metastases. In light of these efforts, topics related to lymphatic metastases, such as skip metastasis and micrometastasis, still remain the subject of investigation. A review of the recent literature shows that the incidence of macroscopic skip metastasis is approximately 25%. Despite the occurrence of skip metastases, a generalized lymphatic drainage pattern is observed and is consistent with the drainage patterns that are observed among nonskip metastases to the mediastinum. Direct mediastinal drainage or the ina... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3354122 Thu, 11 Mar 2010 18:09:36 +0100 3354122 http://www.medworm.com/index.php?rid=3354121&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909001476%2Fabstract%3Frss%3Dyes Lymph node metastasis is the most important prognostic factor in localized non-small cell lung cancer. In case of nodal involvement, the survival rate can be expected to be approximately half of that for a patient with N0 status. Currently, adjuvant chemotherapy is recommended for all patients with histologically positive lymph nodes after resection. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3354121 Thu, 11 Mar 2010 18:09:36 +0100 3354121 http://www.medworm.com/index.php?rid=3354120&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067910000080%2Fabstract%3Frss%3Dyes (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3354120 Thu, 11 Mar 2010 18:09:36 +0100 3354120 http://www.medworm.com/index.php?rid=3354119&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067910000079%2Fabstract%3Frss%3Dyes (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3354119 Thu, 11 Mar 2010 18:09:36 +0100 3354119 http://www.medworm.com/index.php?rid=3354118&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067910000067%2Fabstract%3Frss%3Dyes (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3354118 Thu, 11 Mar 2010 18:09:36 +0100 3354118 http://www.medworm.com/index.php?rid=3354117&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067910000043%2Fabstract%3Frss%3Dyes (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3354117 Thu, 11 Mar 2010 18:09:36 +0100 3354117 http://www.medworm.com/index.php?rid=3026446&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909000434%2Fabstract%3Frss%3Dyes The evidence for the treatment of tracheal tumors rests on a small number of single-institution series, national surveys, and epidemiologic studies. From this evidence, the following observations have been made: tracheal tumors are rare and must be identified among a much larger number of metastatic malignant tracheal lesions; most tracheal tumors are malignant; most tracheal tumors in selected series are resectable; and survival after resection exceeds survival after nonoperative treatment, even if resection margins are close. A discussion of evaluation and treatment of these tumors in this review proceeds along a systematic series of questions. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3026446 Wed, 25 Nov 2009 17:01:38 +0100 3026446 http://www.medworm.com/index.php?rid=3026445&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909000859%2Fabstract%3Frss%3Dyes Postintubation tracheal stenosis is caused by either cuff-induced ischemic damage to the trachea, stomal injury from a tracheostomy, or a combination of the two. Patients who present with stridor or unexplained dyspnea after a period of mechanical ventilation should be investigated for postintubation tracheal stenosis. Most patients with such an injury are candidates for tracheal resection and reconstruction. The length of the anticipated resection is the most important determinant of resectability. Tracheal resection is now a standardized operation with predictable, reliable, good results. The principles of operative repair include precise bronchoscopic assessment, complete tracheal mobilization, dissection close to the trachea to avoid recurrent nerve injury, and precise anastomotic tech... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3026445 Wed, 25 Nov 2009 17:01:38 +0100 3026445 http://www.medworm.com/index.php?rid=3026444&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909000689%2Fabstract%3Frss%3Dyes Idiopathic laryngotracheal stenosis is a very rare condition characterized by an inflammatory cicatricial stenosis at the level of the cricoid cartilage and proximal trachea. Treatment options range from conservative short-term solutions to definitive surgical resection and reconstruction. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3026444 Wed, 25 Nov 2009 17:01:38 +0100 3026444 http://www.medworm.com/index.php?rid=3026443&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909000446%2Fabstract%3Frss%3Dyes Congenital tracheal surgery is uncommon and few centers have enough experience to make meaningful conclusions about treatment. Short-segment congenital tracheal stenosis is treated by tracheal resection, whereas long-segment stenosis is treated by slide tracheoplasty. Tracheomalacia is treated most commonly by aortopexy if due to simple vascular compression, division of an offending vascular ring if due to a compressing or encircling ring, or by careful observation if not associated with vascular compression. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3026443 Wed, 25 Nov 2009 17:01:38 +0100 3026443 http://www.medworm.com/index.php?rid=3026442&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909000860%2Fabstract%3Frss%3Dyes This article reviews the core principles and techniques available to the interventionalist managing central airway obstruction. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3026442 Wed, 25 Nov 2009 17:01:38 +0100 3026442 http://www.medworm.com/index.php?rid=3026441&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909000458%2Fabstract%3Frss%3Dyes Flexible and rigid bronchoscopy are the thoracic surgeon's stethoscope. These tools are vital to evaluating, diagnosing, and treating a tracheobronchial pathologic condition. Airway dilation, used appropriately and selectively, is an effective method of treating various tracheal pathologic conditions. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3026441 Wed, 25 Nov 2009 17:01:38 +0100 3026441 http://www.medworm.com/index.php?rid=3026440&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS104306790900080X%2Fabstract%3Frss%3Dyes Multidetector computed tomography (CT) allows for an accurate, noninvasive means of evaluating tracheal anatomy and pathology. The integration of information obtained from axial images, multiplanar reformats and 3-D rendering enables precise anatomical localization of tracheal pathology, provides detailed information on surrounding structures, aids in surgical planning, and allows for assessment of posttreatment response. Although bronchoscopy remains the gold standard in the diagnosis of tracheal pathology, the proper utilization of radiologic imaging can allow for improved patient care. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3026440 Wed, 25 Nov 2009 17:01:38 +0100 3026440 http://www.medworm.com/index.php?rid=3026439&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909000938%2Fabstract%3Frss%3Dyes This edition of Seminars in Thoracic and Cardiovascular Surgery is devoted to airway surgery. Dr. Sharma is a dedicated chest radiologist with many years of experience in radiologic evaluation of chest diseases. Although in the past plain radiographs and tomography were used for the evaluation of the airway, computed tomography has assumed a primary role. The primacy of computed tomographic evaluation of the trachea is emphasized and numerous characteristic images are displayed. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3026439 Wed, 25 Nov 2009 17:01:38 +0100 3026439 http://www.medworm.com/index.php?rid=3026438&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909000926%2Fabstract%3Frss%3Dyes Over the past 8 years, new techniques and perhaps more significantly new technology have expanded the possibilities for minimally invasive coronary artery bypass grafting. In this section, we review 3 important and potentially enabling technologies: (1) robotics, (2) anastomotic connectors, and (3) the expanding role of imaging in the context of combined operating room/catheterization laboratories (hybrid suites). (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3026438 Wed, 25 Nov 2009 17:01:38 +0100 3026438 http://www.medworm.com/index.php?rid=3026437&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909000884%2Fabstract%3Frss%3Dyes The long-term benefits of a left internal mammary artery bypass graft to the left anterior descending artery (LAD) have been well described. As the patient population with multivessel coronary artery disease has grown older with greater comorbidities, less invasive approaches to revascularization have been explored. The use of drug-eluting stents has minimized the morbidity of revascularization but has failed to match the durability of coronary artery bypass grafting (CABG). Hybrid coronary revascularization (HCR) is the planned use of minimally invasive surgical techniques for left internal mammary artery-LAD grafting and the use of percutaneous coronary interventions (PCI) for non-LAD target revascularization. The optimal timing and order of revascularization in HCR remains unclear. Nove... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3026437 Wed, 25 Nov 2009 17:01:38 +0100 3026437 http://www.medworm.com/index.php?rid=3026436&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909000902%2Fabstract%3Frss%3Dyes Off-pump coronary artery revascularization requires a unique skill set and a different conduct of operation compared with on-pump coronary artery bypass. Not only must the surgeon perform anastomoses on the beating heart, but he/she must understand the hemodynamic consequences of cardiac positioning and stabilization, the effects of regional ischemia on hemodynamic function, contractility, and arrhythmias, and the importance of anesthesia and grafting sequence given variants of anatomy and clinical conditions. Given these differences, the ability to teach off-pump coronary artery bypass to residents and surgeons places unique demands on the teaching surgeon. In this article, we review the available literature about the safety and efficacy of teaching off-pump coronary artery bypass to resi... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3026436 Wed, 25 Nov 2009 17:01:38 +0100 3026436 http://www.medworm.com/index.php?rid=3026435&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909001130%2Fabstract%3Frss%3Dyes In an attempt to advance the surgical treatment of coronary artery disease, surgeons sought a way to offer the proven benefits of coronary revascularization and avoid the side effects of cardiopulmonary bypass by performing revascularization in the beating heart (off-pump coronary artery bypass). This review will describe the development and refinement of the technique, pitfalls to its widespread adoption, and an up-to-date assessment of current results. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3026435 Wed, 25 Nov 2009 17:01:38 +0100 3026435 http://www.medworm.com/index.php?rid=3026434&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909000914%2Fabstract%3Frss%3Dyes Graft patency strongly influences early and late outcomes after coronary artery bypass grafting (CABG) surgery. The current standard of care in CABG surgery does not require intraoperative imaging. Because coronary angiography is rarely available in the operating room (OR), other techniques have been developed to assess graft integrity intraoperatively. The 2 most commonly used are the transit time flow measurement (TTFM) and the intraoperative fluorescence imaging (IFI). The TTFM is a quantitative volume flow technique, whereas the IFI is based on the fluorescent properties of indocyanine green. TTFM cannot define the degree of graft stenosis nor discriminate between the influence of the graft conduit and the coronary arteriolar bed on the mean graft flow. IFI provides a “semiquantitati... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3026434 Wed, 25 Nov 2009 17:01:38 +0100 3026434 http://www.medworm.com/index.php?rid=3026433&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909000896%2Fabstract%3Frss%3Dyes Recent advances in medical therapy, percutaneous myocardial revascularization, and coronary artery bypass grafting have allowed patients to live longer without eliminating the underlying pathology of coronary artery disease. In this review the authors discuss surgical options, perioperative assessment, procedural details, and outcomes after repeated coronary artery bypass surgery and coronary endarterectomy, in patients with severe coronary artery disease that is not suited for further percutaneous coronary intervention. Furthermore, the authors also discuss the role of transmyocardial revascularization and protein/gene therapy in those extreme situations where complex coronary artery disease is no longer amenable to traditional surgical intervention. (Source: Seminars in Thoracic and Card... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3026433 Wed, 25 Nov 2009 17:01:38 +0100 3026433 http://www.medworm.com/index.php?rid=3026432&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909000872%2Fabstract%3Frss%3Dyes Despite advances in percutaneous coronary intervention, coronary artery bypass grafting remains the most effective intervention for complex coronary artery disease in survival, freedom from reintervention, and cost-effectiveness. To ensure that patients have access to this “gold-standard” treatment, a multidisciplinary team approach, rather than an individual cardiologist acting as a “gatekeeper,” should be the standard of care when intervention is necessary, to ensure transparency, real patient choice, and genuine informed consent. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3026432 Wed, 25 Nov 2009 17:01:38 +0100 3026432 http://www.medworm.com/index.php?rid=3026431&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909001129%2Fabstract%3Frss%3Dyes Coronary artery disease (CAD) has been, and remains, the leading cause of death in the USA. Both coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) represent important and well-established modalities for the mechanical revascularization for patients with obstructive CAD. Both CABG and PCI are among the most commonly performed procedures in North America and Europe. Sole CABG in combination with medical therapy and sole PCI in combination with medical therapy, have both been shown to relieve symptoms and, in certain circumstances, prolong life. Although sole CABG confers superior long-term survival in high-risk patients compared with multivessel PCI, its beneficial effects in low to intermediate risk patients are not as clear. The aspect of CABG with clear a... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3026431 Wed, 25 Nov 2009 17:01:38 +0100 3026431 http://www.medworm.com/index.php?rid=3026430&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909001269%2Fabstract%3Frss%3Dyes (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3026430 Wed, 25 Nov 2009 17:01:38 +0100 3026430 http://www.medworm.com/index.php?rid=3026429&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909001257%2Fabstract%3Frss%3Dyes (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3026429 Wed, 25 Nov 2009 17:01:38 +0100 3026429 http://www.medworm.com/index.php?rid=3026428&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909001245%2Fabstract%3Frss%3Dyes (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3026428 Wed, 25 Nov 2009 17:01:38 +0100 3026428 http://www.medworm.com/index.php?rid=3026427&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909001221%2Fabstract%3Frss%3Dyes (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=3026427 Wed, 25 Nov 2009 17:01:38 +0100 3026427 http://www.medworm.com/index.php?rid=2882831&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909000781%2Fabstract%3Frss%3Dyes Malignant pleural mesothelioma is an aggressive malignancy for which surgical treatment is an option for a subset of patients. A gene ratio test based on the relative expression levels of four genes has been validated in clinical trials to predict which patients will benefit from surgical therapy. A description of the test properties and the independent predictors for outcome are provided. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=2882831 Mon, 12 Oct 2009 15:09:10 +0100 2882831 http://www.medworm.com/index.php?rid=2882830&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909000768%2Fabstract%3Frss%3Dyes Photodynamic therapy (PDT) of the pleura is an experimental treatment aimed at eradicating residual microscopic disease after macroscopic complete resection of malignant pleural mesothelioma (MPM) by means of intracavitary administration. A light-based treatment, PDT consists of 3 components: a nontoxic photosensitizing compound, oxygen, and visible light. The treatment is FDA-approved for several oncological targets, but remains experimental for MPM. PDT can be combined with lung-sparing pleurectomy and decortication and does not preclude other treatments such as adjuvant chemotherapy and/or radiation therapy. Additionally, PDT appears to bolster an immunologic effect by rendering the cancer cells that have been destroyed by the light-activated photosensitizer more presentable to the immu... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=2882830 Mon, 12 Oct 2009 15:09:10 +0100 2882830 http://www.medworm.com/index.php?rid=2882829&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909000793%2Fabstract%3Frss%3Dyes Over the last decade, several improvements have been made in the diagnosis and treatment of malignant pleural mesothelioma, including better understanding of tumor biology, availability of more potent chemotherapeutic drugs, improved surgical management, and optimized multidisciplinary therapy. Radical tumor resection by means of extrapleural pneumonectomy (EPP) is now feasible with acceptable morbidity and mortality, even after neoadjuvant chemotherapy, if performed in specialized centers. To date, the best survival data have been reported after multimodality treatment strategies that include surgical resection. In this article, we discuss several strategies that involve EPP or pleurectomy/decortication in combination with various adjuvant and neoadjuvant therapies. (Source: Seminars in T... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=2882829 Mon, 12 Oct 2009 15:09:10 +0100 2882829 http://www.medworm.com/index.php?rid=2882828&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909000707%2Fabstract%3Frss%3Dyes The role of palliative care in the medical management of malignant mesothelioma is multifaceted, requiring proficiency in multiple disciplines. Pain management is a key aspect of this care. The most common sources of pain are postthoracotomy syndrome, chemotherapy-induced peripheral neuropathy, involvement of the intercostal nerves by tumor invading the chest wall, and dyspnea. The palliative care provider also must be prepared to recognize and treat psychological disorders, to identify other social and spiritual sources of distress, including anxiety and depression, and to provide or arrange for counseling to patient and family for advance care planning, as well as grief and bereavement. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=2882828 Mon, 12 Oct 2009 15:09:10 +0100 2882828 http://www.medworm.com/index.php?rid=2882827&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909000732%2Fabstract%3Frss%3Dyes The role of radiation therapy (RT) in the curative treatment of malignant pleural mesothelioma remains undefined. No data clearly support treatment of unresected mesothelioma with definitive RT. Early reports showed that RT was associated with unacceptable toxicity, but recent limited data suggest that treatment with intensity-modulated radiation therapy (IMRT) may be tolerable. Adjuvant RT after pleurectomy is also challenging, and similarly, no clear efficacy has been demonstrated. Some approaches, such as IMRT to the circumferential pleural envelope, appear feasible, but the fact that this approach does not address the disease in the fissures is problematic. The best setting in which to deliver RT is after extrapleural pneumonectomy, but the large and irregular target volume and multipl... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=2882827 Mon, 12 Oct 2009 15:09:10 +0100 2882827 http://www.medworm.com/index.php?rid=2882826&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909000744%2Fabstract%3Frss%3Dyes This article surveys the current clinical landscape of systemic therapies in mesothelioma and explores the impact of both conventional and targeted agents. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=2882826 Mon, 12 Oct 2009 15:09:10 +0100 2882826 http://www.medworm.com/index.php?rid=2882825&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909000720%2Fabstract%3Frss%3Dyes Two operations have evolved for the surgical treatment of malignant pleural mesothelioma (MPM): extrapleural pneumonectomy (EPP) and pleurectomy/decortication (P/D). The goal of surgery in the multimodality treatment approach is to achieve a macroscopic complete resection, with adjuvant therapies directed at residual microscopic disease. Overall survival reported in a recent multicenter analysis of these two operations supports the use of P/D for early stage MPM provided that a complete resection is feasible; otherwise EPP will confer a survival advantage. For stage II disease, however, EPP demonstrates a possible advantage. The focus in stage III disease should remain on the ability to achieve macroscopic complete resection, rather than N2 disease. Patients with stage IV cancers have bett... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=2882825 Mon, 12 Oct 2009 15:09:10 +0100 2882825 http://www.medworm.com/index.php?rid=2882824&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909000847%2Fabstract%3Frss%3Dyes Trimodality treatment of malignant pleural mesothelioma with cytoreductive surgery followed by radiation and chemotherapy has resulted in long-term survival for a select group of patients. Knowledge of the similarities and differences between the two operations that have evolved—extrapleural pneumonectomy and pleurectomy/decortication—is prerequisite to understanding the complex issues associated with patient selection, diagnosis, pathologic staging, preoperative assessment, perioperative management, and adjuvant treatment. Both operations are technically complex and should only be performed at experienced high-volume centers. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=2882824 Mon, 12 Oct 2009 15:09:10 +0100 2882824 http://www.medworm.com/index.php?rid=2882823&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909000823%2Fabstract%3Frss%3Dyes Multimodality treatment of malignant pleural mesothelioma (MPM) with surgery, radiation therapy, and adjuvant or neoadjuvant chemotherapy is the sole path to extended survival for select patients with favorable prognostic factors. No single-modality approach has produced equivalent results. Much effort has been expended since first recognition of this insidious pleural cancer to elucidate the underlying cause and optimal treatment strategy. Despite recent breakthroughs, the principal barrier to achieving a cure rests with the propensity for disease recurrence in the ipsilateral hemithorax. Despite these limitations, however, the results hold promise for improved survival with further refinement in patient selection and targeted therapy. Other approaches to multimodality treatment have capi... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=2882823 Mon, 12 Oct 2009 15:09:10 +0100 2882823 http://www.medworm.com/index.php?rid=2882822&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909000690%2Fabstract%3Frss%3Dyes Pathologists play an important role in the surgical management of diffuse malignant pleural mesothelioma, which relies heavily on accurate diagnosis and staging. The pathologist provides crucial input to the determination of many prognostic factors including histologic subtype, extent of local disease progression, resection margins, and nodal status. They consult with the clinical care team at multiple points along the treatment spectrum, preoperatively, intraoperatively, and postoperatively. Finally, they are increasingly called on to guide selection of chemotherapy and measure treatment response. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=2882822 Mon, 12 Oct 2009 15:09:10 +0100 2882822 http://www.medworm.com/index.php?rid=2882821&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909000756%2Fabstract%3Frss%3Dyes Malignant pleural mesothelioma (MPM) is an aggressive pleural tumor with a complex growth pattern. Imaging plays a crucial role in diagnosis and management. Computed tomography (CT) has been the mainstay in the clinical evaluation of MPM; however it underestimates early chest wall invasion, peritoneal involvement, and has well-known limitations in nodal metastatic evaluation. Perfusion CT can evaluate the microvasculature of tumors; however its disadvantages, such as high radiation exposure and side effects from iodinated contrast, have limited its use to research settings. Magnetic resonance imaging (MRI) is superior to CT, both in the differentiation of malignant from benign pleural disease and in the assessment of chest wall and diaphragmatic involvement. Perfusion and diffusion MRI are... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=2882821 Mon, 12 Oct 2009 15:09:10 +0100 2882821 http://www.medworm.com/index.php?rid=2882820&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS104306790900077X%2Fabstract%3Frss%3Dyes Lack of a consensus staging system for malignant pleural mesothelioma has had a profound impact on clinical practice and research, which necessarily relies on comparison of outcomes across multiple institutions and studies for reliable prognostic information. Some lack of agreement arises from the difficulty of conforming this particular cancer to existing staging systems because of its unique biology. The heterogeneous prognosis of patients with differing tumor histology and constant search for new more effective therapies also play a role. Periodic data-driven refinement of staging criteria, based on careful pathologic analysis of histologically homogeneous cohorts, is mandated to provide clinicians with the optimal ability to stratify patients according to survival and select treatments... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=2882820 Mon, 12 Oct 2009 15:09:10 +0100 2882820 http://www.medworm.com/index.php?rid=2882819&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909000719%2Fabstract%3Frss%3Dyes Malignant mesothelioma is characterized by its association with asbestos, its long latency period, and the propensity for the diagnosis to be obtained in the later stages of the disease. Because the high-risk cohorts for mesothelioma are fairly well defined by the association with asbestos, and the exposure is usually in the workplace, it is hypothesized that early detection of the disease could (1) find patients at an earlier, more treatable stage and (2) result in prolonged survival over the present median 12 months from the start of therapy. Many studies have used standard chest X-ray to characterize changes associated with asbestos-exposed individuals, but the insensitivity of X-ray in screening patients with mesothelioma has never supported the wide-scale adaptation of such an effort.... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=2882819 Mon, 12 Oct 2009 15:09:10 +0100 2882819 http://www.medworm.com/index.php?rid=2882818&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909000835%2Fabstract%3Frss%3Dyes Malignant pleural mesothelioma (MPM) is an aggressive cancer of the pleura that is associated with occupational exposure to asbestos and a lengthy latency (up to 50 years) between initial exposure and disease expression. Since recognition of the relationship between the industrial mining and use of asbestos in the 1960s, the incidence of MPM has continued to rise, reaching epidemic proportions in many nations of the world. Despite legislation introduced by numerous industrialized countries in the 1970s, a peak effect will not be observed in many of these nations for at least another decade, owing to the latency of disease expression. In Western Europe, for example, the incidence is not expected to peak until 2020, with an estimated 5,000 new cases per year and more than a quarter of a mill... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=2882818 Mon, 12 Oct 2009 15:09:10 +0100 2882818 http://www.medworm.com/index.php?rid=2882817&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909001014%2Fabstract%3Frss%3Dyes (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=2882817 Mon, 12 Oct 2009 15:09:10 +0100 2882817 http://www.medworm.com/index.php?rid=2882816&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909001002%2Fabstract%3Frss%3Dyes (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=2882816 Mon, 12 Oct 2009 15:09:10 +0100 2882816 http://www.medworm.com/index.php?rid=2882815&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909000999%2Fabstract%3Frss%3Dyes (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=2882815 Mon, 12 Oct 2009 15:09:10 +0100 2882815 http://www.medworm.com/index.php?rid=2882814&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909000975%2Fabstract%3Frss%3Dyes (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=2882814 Mon, 12 Oct 2009 15:09:10 +0100 2882814 http://www.medworm.com/index.php?rid=2644939&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909000343%2Fabstract%3Frss%3Dyes Poland syndrome is characterized by hypoplasia or absence of the breast or nipple, hypoplastia of subcutaneous tissue, absence of the costosternal portion of the pectoralis major muscle, absence of the pectoralis minor muscle, and absence of costal cartilages or ribs 2, 3, and 4 or 3, 4, and 5. The chest wall defect is often associated with a lung hernia. Clinical manifestations are extremely variable and rarely are all the features recognized in 1 individual. Fortunately it is invariably unilateral, allowing for an easier reconstruction. Single-stage reconstruction of the chest wall combined with simultaneous augmentation mammoplasty and transfer of an island pedicle myocutaneous flap of latissimus dorsi muscle are major improvements over previous multiple-stage procedures that provide le... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=2644939 Tue, 28 Jul 2009 12:33:30 +0100 2644939 http://www.medworm.com/index.php?rid=2644938&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909000367%2Fabstract%3Frss%3Dyes Although the issue of the appropriate approach for the repair of pectus excavatum remained unsettled for decades, just when we thought that the consensus was clear, an entirely new method was introduced: the Nuss operation. This technique now challenges not only the previously established standards, but also the basic conceptual views of pectus surgery. In the following text, 2 opposing views on the subject are presented: the angle from which Francis Robicsek, a pioneer in conventional pectus excavatum surgery, views the issue, and the opinion of Andre Hebra, who has extensive experience with the Nuss operation. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=2644938 Tue, 28 Jul 2009 12:33:30 +0100 2644938 http://www.medworm.com/index.php?rid=2644937&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909000392%2Fabstract%3Frss%3Dyes This article reviews the indications for treatment of patients with pectus excavatum, with emphasis on the evolution and outcomes of the procedure known as the minimally invasive repair or Nuss technique. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=2644937 Tue, 28 Jul 2009 12:33:30 +0100 2644937 http://www.medworm.com/index.php?rid=2644936&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS104306790900029X%2Fabstract%3Frss%3Dyes The author discusses different forms of pectus deformities and presents appropriate surgical methods he developed for their correction. For pectus excavatum, the surgical technique includes conservative sub-perichondral resection of deformed costal cartilages and detachment of the xiphoid process. A transverse sternotomy is performed at the upper level of the deformed sternum, which is then bent forward. The corrected sternal position is secured by a “hammock” of synthetic mesh, spread behind the sternum, and attached to the respective cartilage remnants. The pectoralis muscles are then united presternally. The initial steps of pectus carinatum correction are similar to that of pectus excavatum. The sternum, however, is not freed of its environment. A length of 3-4 cm is resected from ... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=2644936 Tue, 28 Jul 2009 12:33:30 +0100 2644936 http://www.medworm.com/index.php?rid=2644935&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909000379%2Fabstract%3Frss%3Dyes Anterior chest wall anomalies vary by age at presentation, signs, and symptoms as well as evaluation and subsequent surgical treatment. The most common abnormalities include pectus excavatum, pectus carinatum, and Poland syndrome. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=2644935 Tue, 28 Jul 2009 12:33:30 +0100 2644935 http://www.medworm.com/index.php?rid=2644934&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909000318%2Fabstract%3Frss%3Dyes There is a large and diverse group of congenital abnormalities of the thorax that manifest as deformities and/or defects of the anterior chest wall and, depending on the severity and concomitant anomalies, may have cardiopulmonary implications. Pectus excavatum, the most common anterior chest deformity, is characterized by sternal depression with corresponding leftward displacement and rotation of the heart. Pectus carinatum, the second most common, exhibits a variety of chest wall protrusions and very diverse clinical manifestations. The cause of these conditions is thought to be abnormal elongation of the costal cartilages. Collagen, as a major structural component of rib cartilage, is implicated by genetic and histologic analysis. Poland syndrome is a unique unilateral chest/hand defici... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=2644934 Tue, 28 Jul 2009 12:33:30 +0100 2644934 http://www.medworm.com/index.php?rid=2644933&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909000410%2Fabstract%3Frss%3Dyes The conditions we call “pectus deformities” were recognized by Hippocrates, the clinical features were described by Bauhinus, treated surgically by Sauerbruch—thus one might rightfully expect that enough time has passed to reach a consensus as to how to move a displaced sternum a few inches higher or lower and keep it in the proper position. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=2644933 Tue, 28 Jul 2009 12:33:30 +0100 2644933 http://www.medworm.com/index.php?rid=2644932&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909000306%2Fabstract%3Frss%3Dyes Health care reform that focuses on improving value enhances both the well-being of patients and the professional satisfaction of physicians. Value in health care is the improvement in health outcomes achieved for patients relative to the money spent. Dramatic and ongoing improvement in the value of health care delivered will require fundamental restructuring of the system. Current efforts to improve safety and reduce waste are truly important but not sufficient. The following three structural changes will drive simultaneous improvement in outcomes and efficiency: (1) reorganizing care delivery into clinically integrated teams defined by patient needs over the full cycle of care; (2) measuring and reporting patient outcomes by clinical teams, across the cycle of care and for identified clus... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=2644932 Tue, 28 Jul 2009 12:33:30 +0100 2644932 http://www.medworm.com/index.php?rid=2644931&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909000422%2Fabstract%3Frss%3Dyes Technological innovation—broadly defined as the development and introduction of new drugs, devices, and procedures—has played a major role in advancing the field of cardiothoracic surgery. It has generated new forms of care for patients and improved treatment options. Innovation, however, comes at a price. Total national health care expenditures now exceed $2 trillion per year in the United States and all current estimates indicate that this number will continue to rise. As we continue to seek the most innovative medical treatments for cardiovascular disease, the spiraling cost of these technologies comes to the forefront. In this article, we address 3 challenges in managing the health and economic impact of new and emerging technologies in cardiothoracic surgery: (1) challenges associ... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=2644931 Tue, 28 Jul 2009 12:33:30 +0100 2644931 http://www.medworm.com/index.php?rid=2644930&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909000355%2Fabstract%3Frss%3Dyes The Michigan Society of Thoracic and Cardiovascular Surgeons created a voluntary quality collaborative with all the cardiac surgeons in the state and all hospitals doing adult cardiac surgery. Utilizing this collaborative over the last 3 years and creating a unique relationship with a payor, an approach to processes and outcomes has produced improvements in the quality of care for cardiac patients in the state of Michigan. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=2644930 Tue, 28 Jul 2009 12:33:30 +0100 2644930 http://www.medworm.com/index.php?rid=2644929&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909000331%2Fabstract%3Frss%3Dyes This article illustrates an effective working model of regional collaboration focused on improving health outcomes, containing costs, and making efficient use of resources in cardiovascular surgical care. The Virginia Cardiac Surgery Quality Initiative is a decade-old collaboration of cardiac surgeons and hospital providers in Virginia working to improve outcomes and contain costs by analyzing comparative data, identifying top performers, and replicating best clinical practices on a statewide basis. The group's goals and objectives, along with 2 generations of performance improvement initiatives, are examined. These involve attempts to improve postoperative outcomes and use of tools for decision support and modeling. This work has led the group to espouse a more integrated approach to perf... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=2644929 Tue, 28 Jul 2009 12:33:30 +0100 2644929 http://www.medworm.com/index.php?rid=2644928&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS104306790900032X%2Fabstract%3Frss%3Dyes Eighty percent of Americans are of the opinion that our country is on the wrong track in so many respects. Fuel prices, health care prices, food prices, education prices, the collapse of our home equity, and our investment equity along with financial industry failures all vouch for change. This should make the election for President fairly predictable with the candidate of the “in-party” out and the candidate of the “out party” a shoo-in. However, that has not been the case. Those of us who have spent a professional lifetime working on the role that public policy plays in incenting systemic solutions for these complex problems might lose our optimism for the nation's capacity to use bad news to effect appropriate change. Not I, nor plenty of others who have been down that path befo... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=2644928 Tue, 28 Jul 2009 12:33:30 +0100 2644928 http://www.medworm.com/index.php?rid=2644927&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909000380%2Fabstract%3Frss%3Dyes As two physicians involved in the leadership of the medical and surgical specialties primarily involved in caring for patients with cardiovascular diseases, which account for a significant percentage of health care expenditures in the USA, we wish to offer several additional observations and recommendations related to health care “reform.” These observations and recommendations are based first on the observation that physicians control at least 75% of health care expenditures through the tests and medications that they order and the procedures that they do. Second, they are based on our belief that medicine remains a profession and not simply another economic or business entity in American society in need of “reform,” such as the banking or automotive industry. We recognize the cri... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=2644927 Tue, 28 Jul 2009 12:33:30 +0100 2644927 http://www.medworm.com/index.php?rid=2644926&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909000409%2Fabstract%3Frss%3Dyes The papers contained in this issue of Seminars in Thoracic and Cardiovascular Surgery were assembled in an attempt to provide an historical context for health care reform, to describe some approaches that have been undertaken to improve quality in cardiothoracic surgery and to then provide some ideas for reform of the American healthcare system. There is general agreement that one of the most important problems facing American society is the continuing escalation of the costs of healthcare at a rate that exceeds the growth of the economy. These differential rates of growth in healthcare expenditures versus the economy are generally viewed as unsustainable, and are exacerbated during periods of economic downturn, as are currently being experienced in the US economy. (Source: Seminars in Tho... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=2644926 Tue, 28 Jul 2009 12:33:30 +0100 2644926 http://www.medworm.com/index.php?rid=2644925&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909000537%2Fabstract%3Frss%3Dyes (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=2644925 Tue, 28 Jul 2009 12:33:30 +0100 2644925 http://www.medworm.com/index.php?rid=2644924&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909000525%2Fabstract%3Frss%3Dyes (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=2644924 Tue, 28 Jul 2009 12:33:30 +0100 2644924 http://www.medworm.com/index.php?rid=2644923&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909000513%2Fabstract%3Frss%3Dyes (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=2644923 Tue, 28 Jul 2009 12:33:30 +0100 2644923 http://www.medworm.com/index.php?rid=2644922&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909000495%2Fabstract%3Frss%3Dyes (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=2644922 Tue, 28 Jul 2009 12:33:30 +0100 2644922 http://www.medworm.com/index.php?rid=2507861&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067908001366%2Fabstract%3Frss%3Dyes Cardiac MRI and CT are imaging modalities increasingly employed in the diagnosis and management of structural heart disease. They are powerful imaging tools that have individual strengths and weaknesses. Rational choice between MRI and CT should be based on a sound understanding of these issues. Management guidelines that incorporate the use of MRI and CT are currently being developed, and their utilizations are expected to grow rapidly in the future. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=2507861 Thu, 25 Jun 2009 09:02:45 +0100 2507861 http://www.medworm.com/index.php?rid=2507860&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS104306790800141X%2Fabstract%3Frss%3Dyes Current technological advances in multidetector-row computed tomography (MDCT) have widened the scope of cardiac CT in ischemic heart disease. Initially employed to determine the status of the coronary arteries, assessment of cardiac function, perfusion, and viability has now become a reality. In this article, basic concepts, technical advances, appropriate clinical indications, and current clinical role of cardiac MDCT in this specific clinical scenario are reviewed. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=2507860 Thu, 25 Jun 2009 09:02:45 +0100 2507860 http://www.medworm.com/index.php?rid=2507859&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067908001391%2Fabstract%3Frss%3Dyes Echocardiography remains the main tool for noninvasive cardiac evaluation. Advances in echo technology and techniques offer new information, which will impact both the timing and method of surgical intervention. Three-dimensional echocardiography, in particular, provides improved tools for quantification both of volumes and of flows. Geometrical relations necessary for understanding functional abnormalities are also preserved with three-dimensional (3D) echocardiography. Finally 3D echocardiography also provides a unique tool for guiding minimally invasive interventions. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=2507859 Thu, 25 Jun 2009 09:02:45 +0100 2507859 http://www.medworm.com/index.php?rid=2507858&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS104306790800138X%2Fabstract%3Frss%3Dyes Valve-sparing aortic root repair (V-SARR) using the David reimplantation method is an increasingly popular alternative to composite valve graft aortic root replacement in patients with aortic root aneurysms or dissections who wish to avoid anticoagulation. Computed tomography (CT) with retrospective electrocardiograph (ECG)-gating has become routine before and following V-SARR at Stanford. CT allows accurate measurement of aortic dimensions and provides unprecedented three-dimensional (3D) images of the sinuses, the aortic valve cusps, and coronary arteries in patients with the Marfan syndrome (MFS), with a bicuspid aortic valve (BAV), or other aortic diseases. This helps the surgeon to conceptualize the size of the aortic grafts required and how much reduction is necessary proximally (aor... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=2507858 Thu, 25 Jun 2009 09:02:45 +0100 2507858 http://www.medworm.com/index.php?rid=2507857&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067908001421%2Fabstract%3Frss%3Dyes Time-resolved three-dimensional (3D) phase-contrast (PC) magnetic resonance imaging (MRI), or four-dimensional (4D) flow, is able to provide robust 3D images with three-directional velocities. This review discusses the technique and application of 4D flow in the imaging of thoracic aortic pathologies. It has been instrumental in describing normal flow patterns throughout the cardiac cycle in the ascending and descending aorta and has shown the variety of flow patterns that exist in ascending aortic aneurysms. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=2507857 Thu, 25 Jun 2009 09:02:45 +0100 2507857 http://www.medworm.com/index.php?rid=2507856&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067908001378%2Fabstract%3Frss%3Dyes This article reviews state-of-the-art pre- and postprocedural imaging for TEVAR, especially focusing on the role of MDCT angiography. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=2507856 Thu, 25 Jun 2009 09:02:45 +0100 2507856 http://www.medworm.com/index.php?rid=2507855&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067908001408%2Fabstract%3Frss%3Dyes The development of retrospective electrocardiographic (ECG)-gating has proved to be a diagnostic and therapeutic boon for computed tomography (CT) imaging of patients with acute thoracic aortic diseases, such as aortic dissection/intramural hematoma (AD/IMH), penetrating atherosclerotic ulcer (APU), and ruptured/leaking aneurysm. The notorious pulsation motion artifacts in the ascending aorta confounding regular CT scanning can be eliminated, and involvement of the sinuses of Valsalva, the valve cusps, the aortic annulus, and the coronary arteries in aortic dissection can be clearly depicted or excluded. Motion-free images also allow reliable identification of the site of the primary intimal tear, the location, and extent of the intimomedial flap, and branch artery involvement. ECG-gated C... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=2507855 Thu, 25 Jun 2009 09:02:45 +0100 2507855 http://www.medworm.com/index.php?rid=2507854&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067908001457%2Fabstract%3Frss%3Dyes This article provides a brief overview of recent technical developments in computed tomography (CT), magnetic resonance (MR), and echocardiography, which have increased our diagnostic understanding and may modulate treatment planning of patients with cardiovascular diseases: electrocardiographically (ECG)-gated CT, 4D-flow magnetic resonance imaging (MRI), and three-dimensional (3D) echocardiography. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=2507854 Thu, 25 Jun 2009 09:02:45 +0100 2507854 http://www.medworm.com/index.php?rid=2507853&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067908001470%2Fabstract%3Frss%3Dyes Medical students, house officers, and cardiovascular surgical residents today cannot be expected to marvel at the tremendous advances our colleagues in radiology and cardiology have made when it comes to imaging the heart, aorta, and peripheral vascular system, since they have been spoiled by these breakthroughs. Older cardiovascular surgeons, conversely, shake their heads in disbelief about how they used to rely solely on contrast single plane RAO left ventriculography to quantitate the degree of mitral regurgitation and determine whether the patient might possibly have a Barlow's mitral valve or catheter aortography in the middle of the night to diagnose an acute aortic dissection, or determine if a blunt trauma patient might have sustained an acute aortic tear at the isthmus. The advanc... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=2507853 Thu, 25 Jun 2009 09:02:45 +0100 2507853 http://www.medworm.com/index.php?rid=2507852&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067908001342%2Fabstract%3Frss%3Dyes We present a review of the experience of robotic thymectomy. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=2507852 Thu, 25 Jun 2009 09:02:45 +0100 2507852 http://www.medworm.com/index.php?rid=2507851&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067908001433%2Fabstract%3Frss%3Dyes Endoscopic techniques for the treatment of reflux disease were first introduced in 2000 as an alternative to laparoscopic antireflux operations. Because of reports of long-term treatment failure with laparoscopic fundoplication and the fact that surgery is increasingly being reserved for the relatively small proportion of patients with complicated reflux disease, attempts to develop safe, effective, and durable endoscopic approaches to antireflux surgery continue. Techniques include radiofrequency ablation, injection therapy, and suturing/stapling techniques. Of these, the suturing/stapling techniques are most similar to the anatomic restructuring of the gastroesophageal junction provided by fundoplication. While early attempts at endoscopic suturing have been disappointing, significant ad... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=2507851 Thu, 25 Jun 2009 09:02:45 +0100 2507851 http://www.medworm.com/index.php?rid=2507850&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067908001305%2Fabstract%3Frss%3Dyes This article reviews endoscopic resection for the management of early esophageal neoplasia, including preprocedural evaluation, appropriate patient selection, available techniques and results of recent clinical trials. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=2507850 Thu, 25 Jun 2009 09:02:45 +0100 2507850 http://www.medworm.com/index.php?rid=2507849&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067908001354%2Fabstract%3Frss%3Dyes The presence of intestinal metaplasia (IM) of the esophagus is associated with an elevated risk for developing high-grade dysplasia and invasive adenocarcinoma. Historically, IM has been surveyed with a lifetime of serial endoscopy and biopsy procedures to monitor for the development of high-grade dysplasia and cancer, the early detection of which would permit intervention with surgery. Several nonsurgical endoscopic procedures have been developed with the intent to eradicate IM and dysplasia and halt progression to invasive cancer. However, many of these techniques have been associated with significant morbidity and unacceptable efficacy outcomes. Radiofrequency ablation (RFA) has more recently been studied to eradicate IM and dysplasia of the esophagus. This manuscript will review the te... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=2507849 Thu, 25 Jun 2009 09:02:45 +0100 2507849 http://www.medworm.com/index.php?rid=2507848&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067908001317%2Fabstract%3Frss%3Dyes Malignant pleural mesothelioma is a uniformly fatal disease with a poor prognosis. Multimodality therapy, including macroscopic complete resection, chemotherapy and/or radiotherapy, has improved survival relative to historical controls, but local recurrence remains problematic. Novel strategies are needed to improve local control. Intracavitary chemotherapy (IC) can deliver higher doses of drug locally with less toxicity than corresponding systemic therapy. When combined with hyperthermia, there is also an increase in local drug absorption and cytotoxic effect. Several phase I and II clinical trials have shown IC to be safe and feasible. Our experience and technique of hyperthermic IC is described. The evolution of our experience has led to the use of pharmacologic renal cytoprotection, wh... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=2507848 Thu, 25 Jun 2009 09:02:45 +0100 2507848 http://www.medworm.com/index.php?rid=2507847&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067908001469%2Fabstract%3Frss%3Dyes This article summarizes the role of stereotactic radiosurgery for the treatment of lung cancer. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=2507847 Thu, 25 Jun 2009 09:02:45 +0100 2507847 http://www.medworm.com/index.php?rid=2507846&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067908001445%2Fabstract%3Frss%3Dyes This article reviews the results for the current procedures under investigation. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=2507846 Thu, 25 Jun 2009 09:02:45 +0100 2507846 http://www.medworm.com/index.php?rid=2507845&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067908001329%2Fabstract%3Frss%3Dyes Lung cancer is the most common cause of cancer related mortality in the United States. Surgical resection is the standard treatment for stage I non-small cell lung cancer (NSCLC). However, many patients who have resectable cancer may have significant comorbidities precluding surgical resection. Radiofrequency ablation is an emerging modality of treatment and may be applicable in this high-risk group of patients. In this article, we review the principles of radiofrequency ablation, the common devices in use, and the results of treatment for stage I non-small cell lung neoplasm. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=2507845 Thu, 25 Jun 2009 09:02:45 +0100 2507845 http://www.medworm.com/index.php?rid=2507844&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067908001330%2Fabstract%3Frss%3Dyes Mediastinoscopy is the gold standard for mediastinal lymph node (MLN) staging for non-small cell lung cancer patients; however, mediastinoscopy is invasive and allows access to a limited number of American Thoracic Society MLN stations (1, 2, 3, 4, and 7). Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is emerging as a useful, less invasive staging technique that offers access to a wider range of MLN stations (2, 3, 4, 7, 10, and 11). Although EBUS-TBNA has excellent sensitivity and diagnostic accuracy, an alternative MLN biopsy technique (i.e., mediastinoscopy or thoracoscopy) is required to confirm negative cytology findings, especially after induction therapy. Additionally, an experienced cytopathologist is critical to establishing an effective EBUS-TBNA pr... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=2507844 Thu, 25 Jun 2009 09:02:45 +0100 2507844 http://www.medworm.com/index.php?rid=2507843&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067908001482%2Fabstract%3Frss%3Dyes In this issue of Seminars in Thoracic and Cardiovascular Surgery, we include a series of articles which highlight new technologies and procedures in general thoracic surgery. These papers were presented as part of the New Technologies and Procedures Symposium at the 88th Annual Meeting of the American Association for Thoracic Surgery, May 10-14, 2008 in San Diego, CA. Thoracic surgery is rapidly evolving and it is critical that surgeons are apprised of new technological advances. Here, several new technologies are featured. (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=2507843 Thu, 25 Jun 2009 09:02:45 +0100 2507843 http://www.medworm.com/index.php?rid=2507842&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909000094%2Fabstract%3Frss%3Dyes (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=2507842 Thu, 25 Jun 2009 09:02:45 +0100 2507842 http://www.medworm.com/index.php?rid=2507841&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909000082%2Fabstract%3Frss%3Dyes (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=2507841 Thu, 25 Jun 2009 09:02:45 +0100 2507841 http://www.medworm.com/index.php?rid=2507840&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909000070%2Fabstract%3Frss%3Dyes (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=2507840 Thu, 25 Jun 2009 09:02:45 +0100 2507840 http://www.medworm.com/index.php?rid=2507839&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.semthorcardiovascsurg.com%2Farticle%2FPIIS1043067909000057%2Fabstract%3Frss%3Dyes (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=2507839 Thu, 25 Jun 2009 09:02:45 +0100 2507839 http://www.medworm.com/index.php?rid=1998445&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19038725%26dopt%3DAbstract Authors: Rusch VW, Azzoli CG, Rosenzweig KE PMID: 19038725 [PubMed - in process] (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=1998445 Mon, 01 Dec 2008 06:34:00 +0100 1998445 http://www.medworm.com/index.php?rid=1998444&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19038726%26dopt%3DAbstract Authors: Decker RH, Wilson LD Adjuvant chemotherapy is now standard therapy following resection of large or locally advanced non-small cell lung cancer (NSCLC), with improvement in survival demonstrated in multiple randomized trials. Despite this, disease recurrence following optimal surgery and adjuvant systemic therapy is common. For patients with locally advanced disease, the majority will have a recurrence within the chest, most commonly at the bronchial stump or in hilar or mediastinal lymphatics. Postoperative radiation therapy (PORT) has been shown to decrease local and regional recurrences, an effect noted most clearly in stage N2 patients and those with positive surgical margins. An improvement in overall survival, similar to that following adjuvant chemotherapy, has not been ... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=1998444 Mon, 01 Dec 2008 06:34:00 +0100 1998444 http://www.medworm.com/index.php?rid=1998443&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19038727%26dopt%3DAbstract Authors: Berman AT, Rengan R The standard curative approach for the treatment of inoperable non-small cell lung cancer (NSCLC) is definitive radiotherapy. Advanced treatment techniques have been developed that maximize radiation dose delivery to the tumor while minimizing the dose to critical surrounding structures. These radiation therapy techniques include three-dimensional conformal radiotherapy, intensity modulated radiation therapy, stereotactic body radiotherapy, and particle beam radiotherapy. Biological imaging with (18)F-FDG-PET and other novel tracers in development have shown the potential to improve target delineation and patient selection for curative treatment. Tumor motion control with respiratory gating techniques and image-guided radiation therapy are recent developmen... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=1998443 Mon, 01 Dec 2008 06:34:00 +0100 1998443 http://www.medworm.com/index.php?rid=1998442&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19038728%26dopt%3DAbstract Authors: Wakelee H, Chhatwani L Surgery remains the mainstay of therapy for early stage non-small cell lung cancer (NSCLC), but even for stage IA, disease relapse rates remain as high as 30%. Patients with completely resected (R0) N1 disease have about a 50% chance of relapse. In the past 5 years, the benefit of adjuvant chemotherapy has finally been demonstrated for patients with lung cancer. Improvements of 5% to 10% 5-year survival have been reported with cisplatin-based chemotherapy. Still, cure rates have significant room for improvement and ongoing trials with "targeted" agents such as those active against the vascular endothelial growth factor (VEGF), epidermal growth factor receptor (EGFR), and vaccine therapy will hopefully further increase the odds for patients with resected ... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=1998442 Mon, 01 Dec 2008 06:34:00 +0100 1998442 http://www.medworm.com/index.php?rid=1998441&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19038729%26dopt%3DAbstract Authors: Price KA, Azzoli CG, Gaspar LE Patients with unresectable stage III nonsmall cell lung cancer (T4, N3, or bulky N2) live longer if they receive chemotherapy before or concurrent with thoracic irradiation. Randomized clinical trials have shown that concurrent chemoradiation is superior to sequential chemotherapy followed by radiation, with a 20% reduction in the risk of death compared with the sequential approach. However, concurrent chemoradiation is more toxic than the sequential approach, with an increased risk of radiation esophagitis, pneumonitis, and cytopenias, including febrile neutropenia. The phase III trials showing the superiority of the concurrent approach all used cisplatin-based chemotherapy and enrolled patients with a good performance status. For patients who a... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=1998441 Mon, 01 Dec 2008 06:34:00 +0100 1998441 http://www.medworm.com/index.php?rid=1998440&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19038730%26dopt%3DAbstract Authors: Fathi AT, Brahmer JR Non-small cell lung cancer (NSCLC) is a common, often fatal malignancy, and is most frequently diagnosed in the advanced stage. Systemic chemotherapy for advanced (Stage IIIB and IV), inoperable NSCLC has evolved over the course of the last few decades. Survival advantage was first noted with platinum chemotherapy, with ultimate development of platinum-containing doublet combinations, which have now become standard of care in the treatment of advanced NSCLC. Over the course of the last few years, multiple nonplatinum combinations have also been demonstrated to be efficacious, and the addition of bevacizumab to existing doublet regimens has improved outcomes in this population of patients. Maintenance regimens for advanced stage NSCLC are currently under ex... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=1998440 Mon, 01 Dec 2008 06:34:00 +0100 1998440 http://www.medworm.com/index.php?rid=1998439&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19038731%26dopt%3DAbstract This article reviews the role of currently available and emerging EGFR inhibitors in the treatment of NSCLC. PMID: 19038731 [PubMed - in process] (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=1998439 Mon, 01 Dec 2008 06:34:00 +0100 1998439 http://www.medworm.com/index.php?rid=1998438&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19038732%26dopt%3DAbstract Authors: Acker MA PMID: 19038732 [PubMed - in process] (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=1998438 Mon, 01 Dec 2008 06:34:00 +0100 1998438 http://www.medworm.com/index.php?rid=1998437&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19038733%26dopt%3DAbstract Authors: Lietz K, Miller LW The landmark Randomized Evaluation of Mechanical Assistance in the Treatment of Congestive Heart Failure (REMATCH) trial demonstrated that the implantation of left ventricular assist devices (LVADs) as an alternative to heart transplantation, or destination therapy (DT) is superior to any known medical therapy in patients with end-stage heart failure who are not eligible for transplantation. In this article, we review results of the first United States and European clinical trials of DT, including the REMATCH, the Investigation of the Non-Transplant Eligible Patients who are Inotrope Dependent (INTREPID), and the Clinical Utility Baseline Study (CUBS) trials, as well as the outcomes of the first DT implantations in the post-REMATCH era in the United States. ... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=1998437 Mon, 01 Dec 2008 06:34:00 +0100 1998437 http://www.medworm.com/index.php?rid=1998436&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19038734%26dopt%3DAbstract Authors: Maybaum S, Kamalakannan G, Murthy S It is estimated that approximately 100,000 patients in the United States with advanced heart failure might benefit from cardiac transplantation, while donors are available for only 2000 recipients each year. Left ventricular assist devices (LVADs) are used both for bridge to transplantation and for long term support in patients ineligible for transplant. Both cardiac transplantation and long term LVAD therapy are limited by the complications of immunosuppression and device malfunction. Currently, a major focus of investigation in advanced heart failure is the temporary use of LVADs as a bridge to recovery of the native heart. While end-stage heart failure was once thought to be irreversible, research now suggests that LVAD support may lead t... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=1998436 Mon, 01 Dec 2008 06:34:00 +0100 1998436 http://www.medworm.com/index.php?rid=1998435&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19038735%26dopt%3DAbstract Authors: Morris RJ End-stage congestive heart failure remains the leading cause of death in the United States. Despite advances in medical treatment, it also remains the most common reason for admission to the hospital. The gold standard of treatment for the failing heart, orthotopic heart transplantation, is limited by a shortage of donor hearts. There are also a significant number of patients who are not transplant candidates due to comorbid conditions and/or inability to tolerate immunosuppressive therapy. To meet the need for this latter group, the medical field has embraced ventricular assist device (VAD) therapy to extend survival and improve quality-of-life for the end-stage cardiac patient. This therapy, however, has been currently limited to the failing left ventricle and is s... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=1998435 Mon, 01 Dec 2008 06:34:00 +0100 1998435 http://www.medworm.com/index.php?rid=1998434&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19038736%26dopt%3DAbstract Authors: Pagani FD Left ventricular assist device (LVAD) therapy has become an established treatment option for patients with advanced heart failure. Broader application of this therapy has been limited by the risk profile of the current generation of devices. The development of continuous-flow rotary pump technology with noncontact bearing design offers the promise of improved device durability and safety profile. Clinical evaluation of these innovative pump designs are currently underway. PMID: 19038736 [PubMed - in process] (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=1998434 Mon, 01 Dec 2008 06:34:00 +0100 1998434 http://www.medworm.com/index.php?rid=1998433&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D19038737%26dopt%3DAbstract Authors: John R The increased applicability and excellent results with left ventricular assist devices (LVADs) have revolutionized the treatment options available for patients with end-stage heart failure. Until recently, most patients who have undergone LVAD implantation have been supported by pulsatile devices. Unfortunately, the use of the latter devices is associated with significant comorbidity, primarily as a result of their large size and limited durability. The HeartMate II and the Jarvik 2000 pumps, both of which incorporate axial-flow and rotary pump technology represent the next generation of devices. The clinical use of these newer axial-flow pumps have resulted in superior outcomes, including significantly reduced complication rates with improved durability. However, as wi... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=1998433 Mon, 01 Dec 2008 06:34:00 +0100 1998433 http://www.medworm.com/index.php?rid=1716734&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18707638%26dopt%3DAbstract Authors: Li RK, Weisel RD PMID: 18707638 [PubMed - in process] (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=1716734 Wed, 20 Aug 2008 09:02:06 +0100 1716734 http://www.medworm.com/index.php?rid=1716733&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18707639%26dopt%3DAbstract Authors: Fedak PW Structural ventricular remodeling determines the clinical progression of heart failure and has emerged as an important target for the development of novel medical and surgical therapeutic strategies. Cell transplantation is an innovative biologic therapy that may restore myocardial structure and function in failing hearts. With current forms of cell transplant therapy, true myocardial regeneration has been limited. However, cell transplantation can predictably limit maladaptive ventricular remodeling through multiple synergistic paracrine mechanisms. Some of the paracrine factors released by transplanted cells have been defined. These paracrine signals may provide beneficial effects by stimulating angiogenesis, limiting matrix disruption, and preventing apoptosis. In ... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=1716733 Wed, 20 Aug 2008 09:02:06 +0100 1716733 http://www.medworm.com/index.php?rid=1716732&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18707640%26dopt%3DAbstract Authors: Cheng AS, Yau TM Within the last few years, it has become evident that the beneficial effect of cell transplantation on ventricular function and myocardial perfusion is in large part mediated through paracrine effects on the host myocardium. Studies in which medium conditioned by cultured cells, usually mesenchymal stem cells, were injected into infarcted animal hearts have provided definitive evidence of this mechanism of action. Paracrine effects of the donor cells include but are not limited to angiogenesis, mobilization of both circulating and bone-marrow-derived stem cells, activation of cardiac-resident stem cells (CRSCs), and stabilization of the extracellular matrix (ECM). These paracrine effects can be augmented by transplantation of cells modified to express therapeu... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=1716732 Wed, 20 Aug 2008 09:02:06 +0100 1716732 http://www.medworm.com/index.php?rid=1716731&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18707641%26dopt%3DAbstract Authors: Pearl J, Wu JC Stem cell therapy holds promise as a therapeutic option for cardiovascular disease. As the field of cellular transplantation matures, novel methodologies are needed to longitudinally track and evaluate the functional effects of transplanted cells. At present, available techniques that hold the greatest promise for tracking cell fate include radionuclide labeling, ferromagnetic particle labeling, and genetic modification with reporter genes. This review describes the benefits and limitations of each technique and provides a summary of critical issues regarding stem cell transplantation that have been addressed by each imaging modality. PMID: 18707641 [PubMed - in process] (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=1716731 Wed, 20 Aug 2008 09:02:06 +0100 1716731 http://www.medworm.com/index.php?rid=1716730&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18707642%26dopt%3DAbstract Authors: Suuronen EJ, Kuraitis D, Ruel M Cardiac cell therapy has not yet resulted in long-term clinical benefits or major recovery of myocardial function in humans. To date, most of the cardiac effects of cell-based therapy are believed to be mediated by a local angiogenic response rather than by the formation of neosyncytial contractile units such as had initially been hoped for. Therefore, repopulation of the ischemic or infarcted heart with progenitor cells that have vasculogenic potential may be an important mechanism to improve contractile function, both in the presence of viable and nonviable myocardium. This constitutes a focus within scientific reach; however, the low engraftment and viability of progenitor cells after transplantation necessitate the exploration of novel deliv... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=1716730 Wed, 20 Aug 2008 09:02:06 +0100 1716730 http://www.medworm.com/index.php?rid=1716729&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18707643%26dopt%3DAbstract Authors: Chiu RC During the past several years, there have been increasing experimental and early clinical observations indicating that allogeneic, and even xenogeneic, mesenchymal stem cells (MSCs) may be useful for cellular cardiomyoplasty. Although the immune tolerance of MSCs is well established in various in vitro studies, controversies on the in vivo immune tolerance of MSCs persist. Confirmation of the feasibility of allogeneic cellular cardiomyoplasty will have vast clinical implications, since it will provide convenient "off-the-shelf" donor cells, as a vehicle for gene therapy, and avoid the need to use dysfunctional autologous MSCs in senile and/or disabled patients. PMID: 18707643 [PubMed - in process] (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=1716729 Wed, 20 Aug 2008 09:02:06 +0100 1716729 http://www.medworm.com/index.php?rid=1716728&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18707644%26dopt%3DAbstract Authors: Kaminski A, Steinhoff G Since the first reports of the capacity of bone marrow stem cells for use in cardiac repair and regeneration after acute myocardial infarction, today, the therapeutic strategy of direct cell administration during cardiac surgery is entering clinical practice. Here we report on the current knowledge of the "new cellular tool" in the cardiac surgeon's hands that is enabling them to exceed the limits of modern methods for myocardial revascularization and repair in cardiac surgery. Therefore, we discuss preclinical data focusing on bone marrow stem cell types and point to the current mechanistic explanation of their effects. With 7 years' experience after completing Phase I and Phase II clinical trials with cardiac transplantation of autologous intramyocard... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=1716728 Wed, 20 Aug 2008 09:02:06 +0100 1716728 http://www.medworm.com/index.php?rid=1716727&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18707645%26dopt%3DAbstract Authors: Zhang H, Wei YJ, Hu SS Despite significant improvement in the management of congestive heart failure (CHF), it still is a major worldwide public health problem. Currently, cell-based regenerative medicine has been developed as a promising therapeutic option for patients with CHF. Considering the large and growing population, it is estimated that over 5 million patients in China may need such a cell-based therapy to replace or repair the damaged myocardium. Cardiac surgery has emerged as an important player in heart cell therapy in China in recent years. Here, we summarize our achievements in both preclinical and clinical studies of intraoperative cell transplantation, and present our understanding of future research in this attractive field. PMID: 18707645 [PubMed - in pro... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=1716727 Wed, 20 Aug 2008 09:02:06 +0100 1716727 http://www.medworm.com/index.php?rid=1716726&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18707646%26dopt%3DAbstract Authors: Menasché P Although most cardiac cell therapy trials have focused on patients with acute myocardial infarction, attempts at "regenerating" chronically failing hearts have also been performed. These studies have entailed use of skeletal myoblasts and bone marrow-derived cells. In the case of skeletal myoblasts, the randomized placebo-controlled myoblast autologous grafting in ischemic cardiomyopathy (MAGIC) trial has failed to show that myoblast injections increased ejection fraction beyond that seen in controls but the finding that the highest dose of myoblasts resulted in a significant antiremodeling effect compared with the placebo group provides an encouraging signal. In the case of bone marrow cells, surgical injections of the mononuclear fraction combined with corona... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=1716726 Wed, 20 Aug 2008 09:02:06 +0100 1716726 http://www.medworm.com/index.php?rid=1716725&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18707647%26dopt%3DAbstract Authors: Patterson GA PMID: 18707647 [PubMed - in process] (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=1716725 Wed, 20 Aug 2008 09:02:06 +0100 1716725 http://www.medworm.com/index.php?rid=1716724&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18707648%26dopt%3DAbstract Authors: Hachem RR, Trulock EP Historically, waiting time was the primary determinant of lung organ allocation in the United States. Under this system, waiting time grew progressively longer as the annual number of transplants reached a plateau, and every year, a considerable number of candidates died while waiting. In 2005, the lung allocation system changed; under the new system, priority for transplantation is determined by medical urgency and expected outcome. The lung allocation score is based on survival models that estimate waitlist and post-transplant survival, and reflects the net transplant benefit. Early evaluations of the new system indicate that waiting time has decreased, the total number of transplants has increased, waitlist mortality may be decreasing, and survival aft... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=1716724 Wed, 20 Aug 2008 09:02:06 +0100 1716724 http://www.medworm.com/index.php?rid=1716723&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18707649%26dopt%3DAbstract Authors: Botha P, Rostron AJ, Fisher AJ, Dark JH Lung donor selection and management strategy continues to evolve, driven by the scarcity of donor lungs suitable for transplantation and the ever present risk of primary graft dysfunction. Selection, based both on data available at referral and that added by the retrieval team, was traditionally based on the transplant surgeon's clinical experience. Closely analyzed clinical data on factors such as age, gas exchange, gram-stain, and even cytokine expression now allow increased objectivity of decision making. By contrast, the importance of variables such as length of ventilation and even ischemic time remain obscure. Optimal management, the key to promoting the marginal lung toward the ideal, is soundly based on the rapidly increasing app... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=1716723 Wed, 20 Aug 2008 09:02:06 +0100 1716723 http://www.medworm.com/index.php?rid=1716722&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18707650%26dopt%3DAbstract Authors: Puri V, Patterson GA The technical details of lung transplantation have seen considerable refinement with two decades of experience. Recent efforts to expand the donor pool are an exciting development. The technical details of donor organ procurement and the implantation are discussed here with a note to common pitfalls encountered. PMID: 18707650 [PubMed - in process] (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=1716722 Wed, 20 Aug 2008 09:02:06 +0100 1716722 http://www.medworm.com/index.php?rid=1716721&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18707651%26dopt%3DAbstract Authors: Carter YM, Gelman AE, Kreisel D Primary graft dysfunction continues to be a major contributing factor to morbidity and mortality after lung transplantation. This condition is presumed to be the result of ischemia-reperfusion injury, which is associated with the release of endogenous substances that can activate the innate immune system. Primary graft dysfunction has been shown to be an independent risk factor for the development of bronchiolitis obliterans syndrome indicating that it can shape alloimmune responses. In this review, we focus on the classification, pathogenesis, possible prevention strategies, management and consequences of primary graft dysfunction. PMID: 18707651 [PubMed - in process] (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=1716721 Wed, 20 Aug 2008 09:02:06 +0100 1716721 http://www.medworm.com/index.php?rid=1716720&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18707652%26dopt%3DAbstract Authors: Sato M, Keshavjee S Long-term success in lung transplantation continues to be challenged by chronic graft dysfunction, which is manifest as bronchiolitis obliterans syndrome (BOS). The mechanisms of BOS involve both immune-mediated pathways (rejection, autoimmune-like mechanisms), and alloimmune-independent pathways (infection, aspiration, ischemia, primary graft failure), which lead to a fibroproliferative responses. BOS correlates histologically with obliterative bronchiolitis in terminal bronchioles and evidence of aberrant remodeling in the airway epithelium, vasculature, stroma, and lymphoid system. A potentially important mechanism that supports the progressive and therapy-resistant nature of BOS is a continuous cycle of ongoing injury and aberrant remodeling. Namely, an... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=1716720 Wed, 20 Aug 2008 09:02:06 +0100 1716720 http://www.medworm.com/index.php?rid=1425736&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18420117%26dopt%3DAbstract Authors: Calhoon JH PMID: 18420117 [PubMed - in process] (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=1425736 Wed, 07 May 2008 21:01:32 +0100 1425736 http://www.medworm.com/index.php?rid=1386535&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18420117%26dopt%3DAbstract Authors: Calhoon JH PMID: 18420117 [PubMed - in process] (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=1386535 Mon, 21 Apr 2008 07:24:38 +0100 1386535 http://www.medworm.com/index.php?rid=1386534&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18420118%26dopt%3DAbstract Authors: Carpenter AJ Diagnosis of thoracic injury begins with a history of events and examination of the patient. Appropriate radiographic studies will be dictated by the findings on history and physical. Procedural examinations, such as endoscopy or angiography, may also be needed for accurate diagnosis. PMID: 18420118 [PubMed - in process] (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=1386534 Mon, 21 Apr 2008 07:24:38 +0100 1386534 http://www.medworm.com/index.php?rid=1386533&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18420119%26dopt%3DAbstract Authors: Dearmond D, Carpenter AJ, Calhoon JH The primary survey as established by the advanced trauma life support protocol includes a directed history and physical exam aimed at the rapid diagnosis of life-threatening thoracic injuries. Most of these injuries can and should be found and treated during the initial evaluation of the patient without the need for additional diagnostic studies. In this article we review the role of the primary survey in the diagnosis and treatment of major thoracic injuries. PMID: 18420119 [PubMed - in process] (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=1386533 Mon, 21 Apr 2008 07:24:38 +0100 1386533 http://www.medworm.com/index.php?rid=1386532&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18420120%26dopt%3DAbstract Authors: Corneille MG, Stewart RM, Cohn SM Injuries to the upper airways are rare, but carry a significant morbidity and mortality. The degree of injury and presentation varies; thus recognition often requires a high index of suspicion based on mechanism. Effective management of laryngotracheal injuries begins with immediate control of the airway whether by orotracheal and surgical route. Definitive management of upper airway injuries relies on an understanding of the anatomy of the larynx, trachea and surrounding structures. Associated injuries are common and must be addressed concomitantly. Postoperative complications are frequent, requiring perioperative vigilance and long-term follow-up to ensure best outcome. PMID: 18420120 [PubMed - in process] (Source: Seminars in Thoracic a... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=1386532 Mon, 21 Apr 2008 07:24:38 +0100 1386532 http://www.medworm.com/index.php?rid=1386531&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18420121%26dopt%3DAbstract Authors: Mejia JC, Stewart RM, Cohn SM Emergency department thoracotomy (EDT) is defined as a thoracotomy performed in the emergency department for patients who are in extremis. The goals of the procedure are to treat pericardial tamponade, control hemorrhage, treat systemic air embolism, perform open cardiac massage and temporarily occlude the thoracic aorta. The lack of clarity in the medical literature, the need for rapid intervention in those patients deemed appropriate for the procedure, the life and death nature of the decision, and the low but finite functional survival rates following EDT for trauma, have made the conduct of this procedure a subject of great controversy among trauma experts. In this brief review, we summarize the available literature, technical concerns and ind... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=1386531 Mon, 21 Apr 2008 07:24:38 +0100 1386531 http://www.medworm.com/index.php?rid=1386530&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18420122%26dopt%3DAbstract Authors: Bastos R, Baisden CE, Harker L, Calhoon JH The initial approach to penetrating thoracic trauma is directed towards the pathophysiologic syndrome upon presentation. Most patients are successfully treated with drainage tubes. The unstable patient may necessitate thoracotomy at the emergency room to drain cardiac tamponade, provide cardiac massage and control bleeding. The guidelines for this procedure are reviewed. Need for further work-up of potential injuries to other mediastinal organs is frequently screened by computerized tomography. Surgery might still be needed, on a less emergent basis, in order to repair injuries to the trachea/esophagus, retained hemothorax, or to rule out diaphragmatic injury. Laparoscopic and thoracoscopic procedures may be used in specific situation... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=1386530 Mon, 21 Apr 2008 07:24:38 +0100 1386530 http://www.medworm.com/index.php?rid=1386529&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18420123%26dopt%3DAbstract Authors: Weyant MJ, Fullerton DA Blunt thoracic trauma represents a significant portion of trauma admissions to hospitals in the United States. These injuries are encountered by physicians in many specialities such as emergency medicine, pediatrics, general surgery and thoracic surgery. Accurate diagnosis and treatment improves the chances of favorable outcomes and it is desirable for all treating physicians to have current knowledge of all aspects of blunt thoracic trauma. Cardiothoracic surgeons often treat the most severe forms of blunt thoracic injuries and we review the aspects of blunt thoracic trauma that are pertinent to the practicing cardiothoracic surgeon. PMID: 18420123 [PubMed - in process] (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=1386529 Mon, 21 Apr 2008 07:24:38 +0100 1386529 http://www.medworm.com/index.php?rid=1386528&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18420124%26dopt%3DAbstract Authors: Navid F, Gleason TG Blunt and penetrating trauma to the chest can result in great vessel or cardiac injury. Both the diagnosis and management of these thoracic injuries have evolved from more invasive to less invasive strategies paralleling the advent of sophisticated imaging tools and the development of endovascular therapies. Despite these advances, conventional open repair and reconstruction techniques remain important and are often the definitive means toward effective management of these severely injured patients. The following review outlines the historical perspective, diagnosis, and management of blunt thoracic aortic, blunt cardiac, and penetrating cardiac injuries. PMID: 18420124 [PubMed - in process] (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=1386528 Mon, 21 Apr 2008 07:24:38 +0100 1386528 http://www.medworm.com/index.php?rid=1386527&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18420125%26dopt%3DAbstract Authors: Bastos R, Calhoon JH, Baisden CE Flail chest is most often accompanied by a significant underlying pulmonary parenchymal injury and can be a life-threatening thoracic injury. Its management is often complicated by the other injuries it is frequently associated with. Similarly, mortality and morbidity are dictated most often by the associated injuries and findings. Its treatment is complex and should first be one of pain management, judicious fluid resuscitation, and excellent pulmonary toilet. In those patients requiring mechanical ventilatory support, or who require ipsilateral thoracocotomy, rib stabilization may be considered depending on a host of potentially conflicting indications and contraindications. At the end of this section are listed the current major recommendati... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=1386527 Mon, 21 Apr 2008 07:24:38 +0100 1386527 http://www.medworm.com/index.php?rid=1386526&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18420126%26dopt%3DAbstract Authors: Johnson SB The anatomy of the esophagus is unique in that it traverses the neck, chest, and abdomen. As a result, surgeons need to be familiar with the anatomy of all three of these areas to be facile and comfortable in performing esophageal surgery. Traumatic injuries to the esophagus encompass a heterogeneous group of injuries that can be iatrogenic, external, or from physiologic forces. Primary repair of traumatic injuries is preferred when possible; however, if systemic sepsis is present and esophageal resection becomes necessary due to extensive injury or inflammation, immediate reconstruction should be delayed in most cases. Successful management of traumatic esophageal injuries requires prompt and accurate diagnosis and treatment tailored specifically to both the type o... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=1386526 Mon, 21 Apr 2008 07:24:38 +0100 1386526 http://www.medworm.com/index.php?rid=1386525&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18420127%26dopt%3DAbstract Authors: Johnson SB Tracheobronchial injuries (TBI) can be challenging to diagnose, manage, and definitively treat. They encompass a heterogeneous group of injuries that are often associated with other injuries. Although relatively rare, diagnosis and treatment of TBI often requires skillful and creative airway management, careful diagnostic evaluation, and operative repairs that are often resourceful and necessarily unique to the given injury. An experienced surgeon with a high level of suspicion and the liberal use of bronchoscopy constitute the major tools necessary for diagnosing and treating these injuries. Most TBI can be repaired primarily using a tailored surgical approach and techniques specific to the injury. Associated injuries are common, and surgeons must be knowledgeable ... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=1386525 Mon, 21 Apr 2008 07:24:38 +0100 1386525 http://www.medworm.com/index.php?rid=1386524&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18420128%26dopt%3DAbstract Authors: Woosley CR, Mayes TC Trauma remains the leading cause of death for children aged 1 to 14 years. Thoracic trauma is seen in 4% to 6% of pediatric patients presenting to pediatric trauma centers and rarely occurs in isolation. The medical and surgical evaluation of children is a challenging task to even the most experienced physician. Effective treatment of the pediatric trauma patient can only be provided if the physician understands the major pitfalls which are common in the pediatric population. The assessment of the pediatric patient is simplified by an understanding of specific anatomic and physiologic differences between children and adults. While noting children are not small adults, the systematic approach taken towards the evaluation of an adult is similar. Sequential e... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=1386524 Mon, 21 Apr 2008 07:24:38 +0100 1386524 http://www.medworm.com/index.php?rid=1386523&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18420129%26dopt%3DAbstract Authors: Flores HA, Stewart RM The multiply injured patient with significant thoracic and extra-thoracic injuries poses a number of challenges. Pericardial tamponade, tension pneumothorax and massive hemothorax can and should be diagnosed clinically. In more stable patients, chest computed tomography (CT) scan is an excellent screening test. The concept of damage control resuscitation and damage control surgery have shown promise in patients with multiple, critical injuries. Beta-blockade of patients with blunt thoracic aortic injuries can be used as a temporizing damage control measure when the risks of operation or intervention are very high (traumatic brain injury, severe right or bilateral pulmonary contusion, unstable pelvic fractures). Patients with multiple penetrating wounds re... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=1386523 Mon, 21 Apr 2008 07:24:38 +0100 1386523 http://www.medworm.com/index.php?rid=1386522&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18420130%26dopt%3DAbstract Authors: Stewart RM, Corneille MG Although there are a wide range of complications following thoracic trauma, respiratory failure, pneumonia, and pleural sepsis are the most common potentially preventable problems. Respiratory failure and pneumonia are directly related to the severity of the injury and the age and condition of the patient. A program aimed at aggressive pain control, mobilization, and pulmonary care can reduce the risk of respiratory failure, pneumonia, and death in these patients. Pleural sepsis develops in the face of a retained hemothorax, which becomes contaminated with bacteria. The most common source for this contamination is not pneumonia, but external contamination from the wound itself or at the time of placement of the tube thoracostomy. Measures that reduce t... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=1386522 Mon, 21 Apr 2008 07:24:38 +0100 1386522 http://www.medworm.com/index.php?rid=1386521&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18420131%26dopt%3DAbstract Authors: Reddy VS Endovascular techniques and videoscopic assisted thoracoscopic surgery have been selectively applied in the trauma setting. These techniques continue to evolve and have gained acceptance as the treatment of choice for certain traumatic thoracic injuries. PMID: 18420131 [PubMed - in process] (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=1386521 Mon, 21 Apr 2008 07:24:38 +0100 1386521 http://www.medworm.com/index.php?rid=1386520&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18420132%26dopt%3DAbstract Authors: McNeil JD, Pratt JW Current military operations have generated a large number of casualties and have led to the establishment of the first Air Force Theater Hospital since Vietnam. Located at Balad Airbase, Iraq, this hospital is a busy trauma center. Thoracic injuries are relatively infrequent but highly lethal. The cardiothoracic surgeon is uniquely trained to provide sophisticated surgical management to some of the most severely injured patients. The operative experiences of four recently deployed cardiothoracic surgeons are described. Mortality from combat injury in this conflict is lower than in prior wars. Body armor may prevent some fatal injuries. Several features of military medical care process are helping to improve our outcomes-specifically, the development of a tr... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=1386520 Mon, 21 Apr 2008 07:24:38 +0100 1386520 http://www.medworm.com/index.php?rid=1360046&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18395625%26dopt%3DAbstract Authors: Woo YJ PMID: 18395625 [PubMed - as supplied by publisher] (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=1360046 Wed, 09 Apr 2008 20:03:56 +0100 1360046 http://www.medworm.com/index.php?rid=1360045&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18395626%26dopt%3DAbstract Authors: Subramanian VA, Loulmet DF, Patel NC Limited access, off-pump coronary artery bypass grafting for revascularization of all the various coronary arteries is an acceptable alternative to standard on-pump coronary bypass grafting through sternotomy. A variety of small, targeted incisions are used to approach various coronary locations. Technical advances in conduit harvesting, stabilization, cardiac positioning devices, and anastomotic connectors have made these procedures more standardized and replicable. This has resulted in reduced morbidity as a consequence of less invasive approaches. These efforts have paved the way for the ultimate goal of same day surgical coronary revascularization. PMID: 18395626 [PubMed - as supplied by publisher] (Source: Seminars in Thoracic and ... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=1360045 Wed, 09 Apr 2008 20:03:56 +0100 1360045 http://www.medworm.com/index.php?rid=1360044&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18395627%26dopt%3DAbstract Authors: Woo YJ, Seeburger J, Mohr FW As alternatives to standard sternotomy, surgeons have developed innovative, minimally invasive approaches to conducting valve surgery. Through very small skin incisions and partial upper sternal division for aortic valve surgery and right minithoracotomy for mitral surgery, surgeons have become adept at performing complex valve procedures. Beyond cosmetic appeal, apparent benefits range from decreased pain and bleeding to improved respiratory function and recovery time. The large retrospective studies and few small prospective randomized studies are herein briefly summarized. The focus is then directed toward describing specific intraoperative technical details in current clinical use, covering anesthetic preparation, incision, mediastinal access, ... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=1360044 Wed, 09 Apr 2008 20:03:56 +0100 1360044 http://www.medworm.com/index.php?rid=1360043&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18395628%26dopt%3DAbstract This article reviews the technical approaches and outcomes for various procedures. For 2,004 mitral valve repairs, our 30-day in-hospital mortality was 0.2% and for 1,103 aortic valve procedures, it was 0.8%. In addition to both a better cosmetic result and earlier return to work, the benefits include less blood loss, less pain, better respiratory function, and better 1-year survival for mitral valve procedures. Similar results have been obtained for aortic valve procedures. Thus, all patients undergoing isolated aortic or mitral valve repairs are offered a minimally invasive operation. PMID: 18395628 [PubMed - as supplied by publisher] (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=1360043 Wed, 09 Apr 2008 20:03:56 +0100 1360043 http://www.medworm.com/index.php?rid=1360042&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18395629%26dopt%3DAbstract Authors: Webb JG, Lichtenstein S Transcatheter aortic valve implantation has evolved rapidly since the first successful procedure over 5 years ago. The femoral arterial and the left ventricular apical approaches are currently favored. Initial skepticism has to some degree given way to acceptance that the procedure might be a reasonable alternative for selected patients who might be at high risk with conventional thoracotomy and cardiopulmonary bypass. Uncertainty remains about outcomes, implications, durability, and the appropriate role for this new therapy. It appears likely that transcatheter valve implantation will become a more widely available and accepted therapeutic option. PMID: 18395629 [PubMed - as supplied by publisher] (Source: Seminars in Thoracic and Cardiovascular Su... Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=1360042 Wed, 09 Apr 2008 20:03:56 +0100 1360042 http://www.medworm.com/index.php?rid=1360041&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18395630%26dopt%3DAbstract Authors: Wolf RK Surgical ablation for atrial fibrillation (AF) can now be successfully performed utilizing minimally invasive techniques, as surgeon experience with these approaches has increased, and technologic advances in minimally invasive instrumentation have been made. Surgical management of atrial fibrillation, as well as our minimally invasive approach, will be discussed in depth. PMID: 18395630 [PubMed - as supplied by publisher] (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=1360041 Wed, 09 Apr 2008 20:03:56 +0100 1360041 http://www.medworm.com/index.php?rid=1360040&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18395631%26dopt%3DAbstract Authors: Del Nido PJ Minimally invasive techniques have had limited application in congenital cardiac surgery, primarily due to the complexity of the defects, small working area, and the fact that most defects require exposure to intracardiac structures. Advances in cannula design and instrumentation have allowed application of minimal incision techniques but in most cases, cardiopulmonary bypass is still required. Image guided surgery, which uses noninvasive imaging to guide intracardiac procedures, holds the promise of permitting performance of reconstructive surgery in the beating heart in children. PMID: 18395631 [PubMed - as supplied by publisher] (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=1360040 Wed, 09 Apr 2008 20:03:56 +0100 1360040 http://www.medworm.com/index.php?rid=1360039&cid=s_33254_157_f&fid=33254&url=http%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fentrez%2Fquery.fcgi%3Ftmpl%3DNoSidebarfile%26db%3DPubMed%26cmd%3DRetrieve%26list_uids%3D18395632%26dopt%3DAbstract Authors: Salgo IS Three-dimensional echocardiography has emerged as an essential tool for visualizing cardiac anatomy and for making more accurate measurements of cardiac structure and function. Recently, improvements in 3D beam-forming and transducer technologies have allowed higher resolution imaging from a transesophageal echocardiographic probe. This is creating new avenues for real-time visualization of intracardiac procedures without the need for cardiopulmonary bypass or opening the beating heart. Evolutions in visualization will allow a wider array of reparative procedures to be performed minimally invasively within a beating heart. PMID: 18395632 [PubMed - as supplied by publisher] (Source: Seminars in Thoracic and Cardiovascular Surgery) Seminars in Thoracic and Cardiovascular Surgery journals http://www.medworm.com/rss/comments.php?id=1360039 Wed, 09 Apr 2008 20:03:56 +0100 1360039